Session 2

×

Session 2 - Health care in Canada – How might it drive economic growth?

CARLY WEEKS: Good afternoon, and welcome, everyone, to this event. I'm really looking forward to having this discussion today with a range of experts on some really important topics that have impacted everybody during the last two years.

My name is Carly Weeks. I am a health reporter with The Globe and Mail. And I will be your host and moderator during this event. I would like to acknowledge first that The Globe and Mail headquarters is situated on land in the traditional territory of the Wendat, the Anishinaabe, the Haudenosaunee, and the Métis Nation, as well as the Mississaugas of the Credit First Nation.

During this broadcast, if there are any technical issues, you can click on the Help Desk icon to try and resolve those. We're also going to be looking for questions for the panelists or for the first interview guests that I'll be speaking to right off the bat. So if you do have a question, please submit that. And we will get to those in due course.

The pandemic has obviously impacted everybody's lives-- given the fact we're speaking virtually-- personally and professionally for all of us. Today we're going to be discussing what some of those impacts have been, what impacts there are for the health care system, the intersection of health and the economy, and where we go from here. I think we can all agree that there are many longstanding issues with the Canadian health care system that the pandemic has brought to light. And it's also exacerbated some of them, everything from excessive wait times for surgeries and specialist appointments, to unequal access to care in many parts of the country, as well as even trouble accessing a primary care practitioner.

We also don't often speak enough about the impacts that these problems have on the individual, families, and caregivers around the country. Because of the pandemic, many people have been forced to wait longer than even before when it comes to certain surgeries or procedures or appointments. And it's also disrupted many aspects of the economy forcing many businesses to close, many people have lost their jobs, and ongoing supply chain issues that have affected many parts of the economy. So we're going to be focusing a little bit today on where we go from here and looking at some of the solutions, hopefully, to addressing some of these longstanding crises in our health care system, and where the health care system intersects with the economy, and what we can do about that.

So to speak to me about this, first off the bat, I'm pleased to introduce Nadeem Esmail, who is a senior fellow with the Fraser Institute. Nadeem is in Calgary today. So thank you for joining us here. And right off the bat to get us started, we're speaking about health care and the economy. I want to just ask some of your reflections on what we've seen, the insights you've gained over the last two years and where we do need to go when we think about the intersection of health care and the economy.

NADEEM ESMAIL: I think what's fascinating-- and thank you so much for the opportunity to present today. I think what's fascinating is we entered this pandemic with a fairly poorly resourced health care system, in spite of the fact that it is one of the developed world's most expensive universal access health care systems. We began the pandemic with fewer hospital beds than the vast majority of our peer nations.

In spite of spending more, we have fewer physicians per 1,000 population. We have fewer medical technologies. And that really came to bear as we came through what happened. Our hospital system was overwhelmed much faster than the hospital systems in our peer nations, forcing us into lockdowns quicker, which had significant impacts on the economy.

And remember, that economy is already paying for one of the developed world's most expensive universal access health care systems. So we were spending more, we were getting less. And in part, as a result, we locked down much faster and much more aggressively than other nations may have had to, simply as a result of not having the capacity to look after people. I think that's one of the key things we have to think about as we move forward, is getting Canadians better value for money to really build that support in so that the next time this occurs, or even on the next wave, we're ready with a health care system that is reflective of the amount of money we're putting into it.

CARLY WEEKS: So what does that look like then, specifically? Talking about some of those ways of moving forward, what potential solutions are on the horizon?

NADEEM ESMAIL: Fundamentally, when we look internationally at the health care picture, the Canadian health policy model is just not working for Canadians. And it's quite different from what other nations have been doing for many years very successfully. There are developed nations out there that really don't have any waiting lists in the health care system. There are waiting times, but they're more scheduling delays and moving people around as opposed to an actual queue.

And all of those health care systems have private competition and delivery, have private alternatives in finance, have cost sharing or user fees to encourage more informed decision-making about when and where it's best to access the health care system, of course, with reasonable limits, of course with exemptions for low income populations. They have activity-based funding, paying hospitals for the care actually provided, not budgetary basis. These policies together have developed some world class health care systems in countries like Switzerland, Germany, the Netherlands, health care systems that do a far better job of delivering universal access health care without costing more than the Canadian system.

Even going partway down this road the way Sweden has in the 1990s with activity-based funding and private competition could have a dramatic impact on our value for money here in health care and the health care system's ability to better support a well-functioning economy. Let's not forget that wait times in Canada last year cost Canadians just about $4.1 billion in lost time and productivity as an estimate. That's a significant cost on those waiting. And that could be eliminated by changing the way we perceive our health care system and the way it is structured in policy terms.

CARLY WEEKS: It is interesting to compare ourselves to other developed countries and look at the fact that our outcomes are generally, in many areas, worse. And this is something that was echoed during the most recent federal budget, where Finance Minister Chrystia Freeland said that very thing herself, that we were actually peeing more but we're getting less. I think one of the arguments we often come back to when we're having this debate-- and I would love your take on this-- is that we talk about, well, if our system is not working, then we obviously have to introduce some private component because that is somehow going to magically solve the problem.

In a lot of the conversations I'm having with health policy experts around the country, what they're saying is that we're actually not treating people very well. And what I mean by that is we're waiting for people to get sick, to show up in the hospital, when they probably could have had-- if they had just had care at home, they could have stayed at home longer, and that kind of thing, so sort of a preventive care model, really investing in community care, and keeping people well at home instead of cramming everyone into hospitals because they basically have no other choice. So talk to me a little bit about that because those are a lot of the solutions that some of the-- the experts are saying we need to basically restructure how we deliver health care, instead of just introducing a new competition component to it.

NADEEM ESMAIL: That is something that's happening around the developed world. It's happening in countries across the globe, where the search is out for better ways to deliver health care, deliver health care more proactively, to really explore the boundaries of what we can do with medical technology now. And there have been some fantastic pilots, even in Canada. There's some great work being done around the developed world. And certainly, that will improve the health care system.

But at the end of the day, there will be people who fall ill, who are injured, who require access to a hospital because there is no alternative. And we need a better way to do that as well. And that's where I think it's important to look to countries, like even Australia, which is geographically and demographically not very different from Canada, but that spends less on health care and has a better universal access health care system to show for it because they've structured their health policies quite differently.

We still need a good, high-functioning, well-structured hospital sector to look after those who do need it, while also considering all of the great things that are happening around the world in health care that need to happen here as well. What we can't do is do the old Canadian thing and double back down on an already failing system, on an already failing structure. And I think the concern forward is-- governments are often wont to do that because that's the politically expedient thing to do. It's not the right thing to do for the taxpayers who are paying for the health care system or for the patients who need access to it.

CARLY WEEKS: One of the things that you touched on, obviously, is lost productivity. And there's obviously a cost, in addition to the way people are feeling and injuries and illnesses and those kinds of things. I was wondering if you could just reflect for a couple of moments on the broader impacts on the economy. So I think that's something that-- we obviously, rightly, focused first and foremost on health outcomes. Why do we need to also pay attention to those economic outcomes too?

NADEEM ESMAIL: We have to recognize that when we have delayed access to health care, limited access to the health care system, waiting and having delayed access to elective surgeries-- which are still necessary, they're just not urgent-- that's not a benign process. Waiting for health care does entail some measure of worthy, of mental anguish, of lost productivity at work and leisure, of strained personal relationships. It does entail, for many patients, a decline in their medical condition, which could mean poorer outcomes, could even mean permanent disability or death, all of which would have been avoidable if we had more timely access to health care services.

A recent estimate puts that at about $4 billion of cost on the Canadian economy in terms of the value of lost time. There are other estimates that suggest the true number might even be as much as 10 times that number, depending on how we want to consider the impact. But we know that Canadians, as they are waiting, are losing time at work because they're worried about their health care condition.

They can't go to work. They can't provide for their families. They're having strain on their personal relationships. That permanent disability will have an impact as well.

An interesting example of how this has been dealt with in the workers' compensation is in British Columbia. Expedited surgeries are sometimes more expensive than waiting for the surgery in the public system. However, the savings in terms of reduction and disability payments is far greater than any additional cost in surgery. So we know even within our own country that the workers' compensation boards have figured out that waiting for health care is really remarkably detrimental on a cost analysis.

When we look at the health care system and we think about the economy, we have to reflect not only on how much it costs us directly, but also on the impact it's imposing on those who are waiting for health care, who, when we look internationally, really don't need to be waiting anywhere near as long as they are now. Canada has some of the longest waiting lists for health care in the developed world. And that undoubtedly has a drag on economic activity.

CARLY WEEKS: There's also obviously a very important question about equity. When we talk about introducing more of a private system, introducing competition, the ability to pay will obviously determine under that kind of system how some people are able to access care or how easily they're able to access that care. Geography is already a huge stumbling block. It keeps our, quote, unquote, "universal system" out of reach for many. So what would you say to those people who have those concerns about what is going to happen to them under that kind of a model?

NADEEM ESMAIL: I think there's a misunderstanding about how the private sector can contribute to the improvement of a universal access health care system. If we look at what countries like Australia, Sweden, Switzerland, and others have done, they have involved the private sector and private competition in the public health care system or in the universal access health care system, which means we're improving access for everyone throughout the system by improving value for money, by improving the volume of services provided, by improving the quality of services provided through competition. A private parallel sector does improve access for those who pay for it, but it also has the effect of taking people out of the public health care system.

In Australia, a large number of people are cared for in that private parallel sector. But that allows the publicly-funded sector, the sector that doesn't require patient payment, to focus on those who need the health care and bring waitlists down. Let's never forget that we have one of the developed world's most expensive universal access health care systems and some of the longest waiting lists for access to health care in the developed world. By no means is the Canadian system any sort of beacon for equity and access.

CARLY WEEKS: That is a good point. And I guess, to leave it there, we've spoken a lot about European countries and how more of a hybrid model that they're using does yield better results. When you do look at countries like the US, on the other hand, we all use that as the benchmark for how not to do health care. And as we all know, they don't really have any kind of a universal health system set up. There are ultimately a lot of fears that we'll end up in that kind of a situation, where it is like The Hunger Games for health care. So how do you avoid that kind of thing?

NADEEM ESMAIL: I think the Canada-US comparison is a false dichotomy. We have a government that is focused on universal access health care. The Canadian population clearly desires it, so our policy construct allows us to have that universal access health care system. The question is not, how do we avoid a US model deliberately?

The question is, how do we have a universal access health care system that best serves the needs of Canadian patients and the taxpayers who are funding their care? And the examples around the world are very clear on how to do that better, from Sweden, Switzerland, the Netherlands, Australia, Germany, France, Japan. There are a large number of developed nations that are spending the same or less on health care than we are that have better universal access health care systems to show for it. We need to take those lessons, adopt them, and move forward to the benefit of Canadians.

CARLY WEEKS: Nadeem, thank you, that was such a nice, great wrap-up point. So I'll have to leave it there and just thank you for your time.

NADEEM ESMAIL: Thank you.

CARLY WEEKS: And I'll go right into introducing our next guest. So I am now going to be speaking with Dr. Danyaal Raza, who is a family physician at St. Michael's Hospital, which is part of Unity Health Toronto. He is also past chair of the Canadian Doctors for Medicare. So thank you so much for being here today and speaking about these issues. I think you have an obviously really interesting perspective, having been a physician during this pandemic. Speaking-- or I guess reflecting on some of the comments that we just heard from Nadeem about the devastating effect the pandemic has had on health care, on the economy, what are some of the reflections that you're having right now or insights that you've gained and where we go from here?

DANYAAL RAZA: Yeah, so I'm a family doctor. And I'm very much kind of in the middle of it and providing not only direct care but quarterbacking care for many of my patients. And that's been, of course, true before the pandemic, and it's true now.

When I look back at the lessons of the past two years, I think COVID has emphasized a few things. It's emphasized what we do well in the system, but what we definitely need to do better. So for example, if you look at our acute care outcomes, things like emergency surgery or cancer care, we actually do quite well. And when you saw the way, especially in the first two waves of COVID, our health care system created this incredible ICU capacity, worked not just between hospitals and single provinces, but across jurisdictions, I think that was quite remarkable and just shows what we're capable of.

But of course, that didn't come without a tradeoff. And we're seeing the consequences of that now, where we're having delayed care for chronic care. So not just things like elective surgeries for hips and knees or cataracts, but we're also seeing issues in primary care where I'm working. And we're seeing backup in care there.

And I think it's also highlighted-- when we think about things that are included within Medicare and outside of Medicare, I think it's also highlighted some of those differences. So for example, acute care is something that's covered by a universal health care system. But things that aren't our long-term care. And we saw some of the devastating outcomes in long-term care.

And also pharmacare associated with all of the job loss during the pandemic, I had patients who were losing their employment-linked drug coverage. And I'm writing their prescriptions for things like insulin. It's put us in these very difficult situations. And the good news is I think we actually have a number of solutions that enhance both equity and access that I'm hoping we take seriously.

CARLY WEEKS: I've heard so many people say that this is now the time to have those conversations, that if we don't talk about the changes that we need now, when are we going to? And pharmacare is a perfect example because we've been talking about that for decades at this point. And we're inching ever closer, but still so far out of reach.

You said the magic word of solutions. That's hopefully what we're here to focus on today because we've talked for two years about the problems. What are some of the things that you are thinking about or some of the things that you see from your perspective as something that we really need to bring into the system to improve it?

DANYAAL RAZA: So I'd put them in three categories. Number one is stop underfunding the system. Number two is use the funding that we have but also potential new funding to do things differently, both inside of Medicare, but services outside of Medicare. And then also take a look at what we do outside of our health care system at our economic and social policies and how we can use those to enhance the health of people in Canada.

CARLY WEEKS: What does that look specifically, like on the ground example say, whether it be improving how family care's delivered, hospital care? What are some of the examples you'd cite?

DANYAAL RAZA: Yeah, so let me start with the funding piece because that's always a hot topic. And if you look at overall health care spending, we do spend above average for sure. But when you break it down to public versus private spending, we spend about 70% of all of our health care dollars publicly. And when you compare it to peers in Europe, like the UK, the Netherlands, France, Sweden, they all-- Germany, they spent 75%, 85% publicly.

So we actually-- I think a lot of people are surprised when they hear this. We spend less on our public health care system than many countries we're used to comparing ourselves against. So one is we have to be honest about that. And if we want to have a high functioning universal health care system, then we have to be able to fund it to do those things. But also, we have to use that money in smarter ways that have caught up to the ways that practice has changed.

So for example, something that we're beginning to see more and more, but I think one of the things we always struggle with in spread and scale is how do we connect patients from my office into the offices or the surgical rooms of, for example, orthopedic surgeons who are doing hip and knee replacements? The old school system is, I had my-- I don't have Rolodex, but let's just say I had my list of orthopedic surgeons in my community. And a patient walks in and I said, OK, we've maxed out medical therapy, you need to see a surgeon. And I just pick a name off of my list.

But I have no idea what the waitlists are for the other surgeons. The patient doesn't know. We just kind of put the facts out there, which is another conversation, and we see what comes back. But what we're starting to see and what we need more of are things like single-entry referral systems so we have more transparency around what the waitlists are. Because surgeon B may have a waitlist that's half as long as surgeon, and so there's tons of efficiencies to be gained there.

But also focus on team-based care, which we talk a lot about in primary care with good reason. I'm lucky. I work with social workers, nurse practitioners, nurses, and others. But pairing folks like advanced practice physiotherapists with orthopedic surgeons, because guess what, if you don't need surgery, what's the first-line treatment? It's physiotherapy. But unfortunately, community-based physiotherapy also isn't covered by Medicare. It's one of the-- like pharmacare and long-term care, it's one of the services that fall under our two-tier system.

CARLY WEEKS: One of the things that I've heard from many experts and physicians and other health professionals dating back years is that we really-- it's too much of a hospital-based model, where the patient sort of has to navigate around the system instead of the system navigating or encircling the patient. So that's a really good example of-- you have-- none of your practitioners are talking to the other. And then you're kind of on your own to try and get care in the community. And if you're lucky enough to have maybe have insurance that is generous enough to cover that, then you're in luck. And if not, then you're out of luck.

Is that a-- we talked about introducing more of a private element to-- we already have a lot of private care. On the flip side, there's just really focusing on reorganizing or restructuring how we do things. So I think I know what you'd say, what side you'd come down on.

DANYAAL RAZA: [LAUGHS]

CARLY WEEKS: Why-- I guess what I'd be asking is, can you make the case for why just reorganizing the system can actually lead to better outcomes? It's not just about competition privately.

DANYAAL RAZA: Well, I don't need to make the case because the evidence is out there. I'm here in the grind seeing my patients. I'm also motivated by the problems that my patients are seeing to engage in policy work. That's the reason why I do this work, why I dial in over my lunchtime to have conversations with readers of The Globe on this, and I do my advocacy work.

Because we're actually-- there's a lot that we're not doing. And so we're not coordinating our systems. Our hospitals aren't talking to our family doctors. We haven't-- because we have this different funding system for community-based care, like home care, long-term care, and because oftentimes you have to follow the money, money can bring people together, we have this incredible disconnection and fragmentation of care.

I'll give you another example when it comes to prescription drugs. So I have some of my patients who are on social assistance who have access to the public drug plan, and other patients who have no coverage, and some people who have private job-linked plans. If I write a prescription, and then I get a renewal, and I'm like, oh, this renewal seems a bit early, let me go see it was last renewed, we have the system in Ontario where I can log online.

And I can actually look you see when the medication was dispensed, how much was dispensed, who dispensed it, what pharmacy. But it's only linked to medications that are publicly covered. I don't have any of that information for folks who are paying out of pocket or paying privately. And it's-- again, if we want to follow the money, if we want to bring services together, part of it is actually thinking about how we want to pay with them-- pay for them and being honest about the funding that we need to do it and the tradeoffs that we're making by not moving in that direction.

CARLY WEEKS: Mm-hmm, that's a really good way of putting it. There's a question for you from the audience. And this relates directly to that. So do you think that family practice needs to fundamentally change to be sustainable? So much of the burden on family doctors right now is related to mental health or complex social and medical issues. Could this somehow be outsourced? That's the question.

DANYAAL RAZA: I sort of alluded to this. But I wouldn't frame it as outsourcing. I'd frame it as moving towards more team-based care. So for example, the old school model of a family doctor hanging up their shingle, maybe working with a secretary and nurse, that's, unfortunately, still relatively common, whereas I'm very lucky because I work in a team-based model. I work with social workers, with nurse practitioners. We even have an income security program. We have a children's literacy program.

And so that means that the potential practice size I can have is much larger than a solo family doctor because I'm lucky to work in this team-based model, where there's other folks who can work collaboratively with each other. So I wouldn't frame it as outsourcing. I'd frame it towards team-based model. Some people call it the patient-centered medical home. And if you Google that, you can find out a bit more information about that. But it's really taking primary care seriously and empowering not just family doctors-- we're just one piece of the puzzle-- but all of the other community-based health practitioners that are critical to enhancing access to primary care.

CARLY WEEKS: There's another audience question that I'd like to get to you because I think it's an important one that was so at the forefront in the pandemic. We'll probably be coming back to this during the panel as well. And that's on hospital beds. So we heard so much, we don't have capacity and we're shutting down because we don't have enough beds. And so the camera-- sorry, the question kind of gets at this, but is really-- is it about more beds? I'm kind ad-libbing, so sorry to whoever asked this. But is the problem that we need more beds, or is it that our system relies so much on hospitals that we're not really doing anything else?

DANYAAL RAZA: Yeah. Yes and no. That was cagey. Here's something more direct. So one of the reasons why we have a shortage of hospital beds is because there's a lot of folks in hospital who shouldn't be in hospital. There are people who are waiting for long-term care, but instead, because we don't have enough capacity in long-term care are stuck in hospital because they're safer there than they are at home, or who could even be discharged to their own homes as long as we have sufficient home care support in place. But again, we don't have access to that.

If you can pay out of pocket for home care services, then maybe you can get out of hospital a little bit sooner. But for many folks that's not the case. And so that's part of the reason why we don't have-- why we have the shortage of beds. And part of the reason is also, if you look at international data-- I cited some funding figures initially-- we just have, at baseline, fewer acute care beds than other countries. So it's not one or the other. It's rarely a single answer, a single solution. It's a both here.

CARLY WEEKS: Right, right. So if we are to change the system, if we are to see improvements, we all hear this is the time now. Well, everything's still kind of in disarray. What will it take in your just-- in your viewpoint? Is it political will? Is it just trying to figure out-- I mean, how do we even go about this? We're talking about rejigging this huge system.

DANYAAL RAZA: If we have another Parliamentary report or commission, I'm going to scream.

[LAUGHTER]

Because we've had so many of these. If you look at pharmacare-- I'm just going to use this as an example-- we have had 50 years, 50 years of reports and papers that have all said the same thing-- a universal single payer system. And if we-- and the answer is not another report. It's not another platform commitment. It's actually the political action and political will.

And the confidence supply agreement we saw federally was promising. But if we look at the provincial election in Ontario, only one of the parties has committed to working with the federal government. And even the details between the liberals and the NDP federal agreement, frankly they're lacking. We need more of them. And we need to actually see action instead of just more words on paper.

CARLY WEEKS: Mm-hmm. It's hard to believe we're having that-- I had this exact conversation like five years ago with someone else, so anyway-- with many people. I will wrap up our discussion there and just say thank you so much for joining us. And now I think the panel is just waiting to jump in on all of these hot topics we've addressed. So Danyaal, just thank you so much for being here. And I'm sure we'll be in touch again soon. Thank you so much for your time today.

DANYAAL RAZA: Thank you, Carly.

CARLY WEEKS: And now it's my pleasure to shift to our panel discussion. So we have some very exciting guests here joining us. So I'll introduce them in no particular order. So we have Dr. Katharine Smart, who is president of the Canadian Medical Association. We have Craig Conoley, who is a caregiver and advocate. We have Cheryl Prescod, who is executive director of the Black Creek Community Health Center. And we also have Dante Morra, who is chief of staff and president of THP Solutions at Trillium Health Partners.

So thank you everyone for being here today, for having this discussion. I'll kick things off by talking to Katharine. We're going to go all first names today, guys. And just-- we heard some already really good, robust discussion about all the problems in our health care system and where we need to go from here. And I know that you're thinking a lot about solutions these days and really trying to seize this moment. I wanted to know what some of your thoughts were on two years into this pandemic and what we really need to start thinking about if we're going to take health care improvements and, by and large, economic improvements related to health care seriously.

KATHARINE SMART: Thanks, Carly, for the question. As we heard from our two speakers, there's so much going on. And it can sometimes, I think, feel overwhelming. But I think if we start to really think about what is it that we're trying to achieve and what are the steps that need to happen to get to where we need to be, we can start towards the action that's needed.

So what do we know? We know Canadians value universal health care. And we see this as an important part of our national identity. And we want to continue to invest in that. And we know all Canadians are going to need the health care system at some point.

So jumping off from there, I think what we can say is, this is a key priority. But the problem is we are not getting the return on those investments. The health care system is not functioning well. And many Canadians are not accessing care.

That is just a hard truth. Almost 5 million people without access to primary care, that is not a small number. The surgical backlogs are significant. Many people are suffering. So I think we can all agree we have a problem.

I think what we need is that political will to acknowledge that problem. I think it's challenging because politicians are motivated to tell the public everything's OK. But that's clearly not the case. So I think it would go a long way, both at the federal and provincial level. Our leaders could get on board with us and say, yeah, we hear you, our current system is broken.

We need systems transformation. And let's start down the road of some of the ideas we've heard. Let's change the way care is delivered. Let's move to integrated team-based care. Let's incentivize payments to match the outcomes we want for the population.

Let's leverage data so we actually know what we're doing. We can track these interventions. And we can make sure that we have accountability in the system. And let's allow physicians to work in teams and have them embedded in leadership so that we can learn from their expertise to reimagine the system together. And I think if we could do some of those things, we could start with that action to create the change we want so that we can reinvigorate our health care system I think what's clear is, if we keep just this sort of tinkering Band-Aiding here and there without those significant structural changes, we aren't going to get where we need to be. And Canadians are going to continue to suffer.

CARLY WEEKS: That's a very blunt assessment. And I see Craig has been nodding along throughout. And Craig, I'd love for you to share a little bit of your perspective, some of your experience as a caregiver, the impacts that's had, and some of the things you're thinking about that relate to what we just talked about.

CRAIG CONOLEY: Sure. Before speaking, I would like to acknowledge that I live and work on Algonquin and Anishinaabe territory, which remains unceded and unsurrendered. I would also like to acknowledge the racialized communities that are disproportionately affected by the systemic issues we're talking about today. And I'm incredibly honored to speak on behalf of all patients and caregivers in Canada, especially millennial caregivers. I represent 10.1 million millennials currently living in Canada who will be faced with the challenge of providing care in future.

Before the first wave of COVID struck Ottawa, and almost overnight, I became the caregiver for two parents. My mother had stage four brain cancer. And my father had NASH, nonalcoholic liver disease. One month after losing my mother during the first wave, I successfully donated 61% of my liver to my father. And I would continue to offer care in community following the procedure.

I think it's important that the public knows that the experience of providing care for my parents, pre-COVID and during COVID, was really traumatic. I was not prepared, nor did I have the skills to properly balance my work-life responsibilities, maintain relationships, run my business, advocate for them, and provide around-the-clock care. Even more shocking was the realization that there are limits to the care.

So COVID exposed those limits that existed before. And due to these limits, things like backlogs of procedures, staff-to-patient ratios, burnout, poor infrastructure, as a caregiver, I have to be honest when I say that I've lost trust in our health system. And I do dread having to re-enter it.

CARLY WEEKS: It's very, very difficult, and thank you for sharing that. It sounds like it's been a really, really difficult time. And coming back to you to ask you some more of the insights and things that you've learned in the last couple of years, but I wanted to also bring Cheryl into the chat and just say that you're representing a community that has been so hard hit during the pandemic.

And I think that oftentimes, some racialized communities, marginalized groups, they can get forgotten. They often are when we have these bigger, broader discussions, especially when some of the people making the decisions don't look like them. I wanted to ask you what some of the things-- what things stand out to you during the pandemic, what things you've seen, what desperately needs to change?

CHERYL PRESCOD: So thank you so much for the invitation to participate in this really important conversation. Because this issue is not only close to my heart professionally, but personally because I am one of those racialized groups where I do feel that we have some lessons to learn in how we treat and make accessible the health care, the great health care that we do have in Canada. So for me, some related questions are, is the current system really-- where is it taking us?

Is this system built for everyone? Does it consider the equitable health outcomes for all Canadians? So what we saw over the last two years in this community is the pandemic shining a really bright spotlight on the dark and dirty corners of our health care system. It exposed inequities that act as barriers to care for many of us, especially those that are most vulnerable.

Working in this community for the past two years, I saw the glaring health inequalities inequities particularly faced by racial and social economic challenged groups. This is what characterized the pandemic here in Canada. And I think it is something that we have to acknowledge. And we have to argue that we cannot return to business as usual.

We have to find ways that we can work better together because a healthy community is one that has also built a healthy economy that we are all beneficiaries of. So I think some of the things that we did at Black Creek Community Health Center, which is in the northwest part of Toronto, comprised mostly of racialized groups, folks living in poverty, many newcomers to Canada, is we engaged with them at the ground level. We made care accessible to them, things like access to vaccines, access to testing, but also access to the care they really deserve and needed. Because it wasn't just about COVID. These cracks in the system existed pre-COVID, and they needed to be addressed. And we hope that we can come up with some solutions to address them today.

CARLY WEEKS: Before we move on, I just was wondering, Cheryl, if there is any story that stands out, just either providing someone access and how that led to a change, or how lack of access really harmed someone during the pandemic, just as an illustrated purpose, just some real stories from the community.

CHERYL PRESCOD: So I can share a story of Patrick, not his real name of course, a Black man in the community, who's a home care provider. He ended up being hospitalized with COVID. Patrick lived with his wife, two children, and in-laws, elderly grandparents to his children who provide care.

He had breathing issues. He had a fever. But he continued to work because he works in an essential job without paid sick days or health insurance and extended health benefits. So he continued to work and ended up going into the hospital without a good outcome. His elderly parents ended up passing away because he brought COVID home to them.

And what this shows to us is that, in many communities, especially communities that are racialized, those people make up the bulk of our workforce that are taking care of us. It's stocking the store shelves, taking care of our children in child care centers, our elderly folks in long-term care homes. And many of them do not have the type of income that allows them the benefits of staying home, working from home, and providing what's needed for their families. So they end up working.

Many of them do not want to even take a COVID test at the very beginning because they did not want to know that they were tested positive. So they continue to work, continue to go on public transit. And that's a story that really illustrates some of the challenges of the most vulnerable in our communities.

And unfortunately, many of those most vulnerable are segregated into certain communities that were called hotspots. And there are some solutions and some strategies that we use that I hope I'll have some time to speak about through our high priority community strategy. And I think there are some elements there that really inform where we need to go as a health care system.

CARLY WEEKS: Thank you, Cheryl. And we'll definitely have time for that for sure. Dante, this is a nice segue because, like Cheryl, you saw a lot of the communities that really faced the brunt of COVID, of this pandemic. And I just wonder if you can speak a little bit about some of the insights that you've gained over the last two years and things that you saw that you want changed, where you think the system needs to go next.

DANTE MORRA: Thanks so much, Carly. And there's a lot of great voices in the room. And I'll add one other into it, and that is as providers in large systems. So I'm an internist. So I'm one of those people when you get hospitalized with COVID or other, that you're in the hospital and I take care of you, but also have the pleasure of being an executive at Trillium Gealth Partners, which is a very large hospital system in Mississauga and West Toronto that has about 12,000 people who work there and was actually the organization that had the largest amount of COVID in the population.

So to talk about a couple of things that have already been said, number one, the capacity issue was eliminated in COVID. So if you look at the number of hospital beds per population in Canada, it's the lowest in all of the developed countries. And then if you sort of zoom in to Ontario, it's actually one of the lowest in Canada.

But if you go down to like the Mississauga and Brampton and some of the rings around some of the downtown areas, it's actually some of the lowest in the world. It's sort of like in range of capita as the Philippines. And nothing wrong with the Philippines, but it's actually not known for its hospital capacity. So what COVID did is it actually eliminated some of the stresses and fractures of the system.

And that was everything from mental health to hospital capacity to primary care issues. That's an amazing opportunity because now we have a really good understanding of what we actually need to work upon. It also eliminated some of that health resource challenges of nursing labor and actually how we organize and pay people.

And that's a really big issue that we need to talk about. Because what we know right now is we are committed to a universal model, but there are better models out there. And actually, we have a really good understanding of actually where those problems are. And now we need to move forward.

What it also did was it actually illuminated some of the issues that other panelists have talked about-- people who have to go to work. There were many essential care workers, there was no option. And you heard from Craig talking about caring for family members and that trust piece. And that's a really important issue around the social determinants of how sick days and policy that actually is a really big part of health care that we need to address.

And then there were some bright lights. So for the first time that I've seen, what we started to see is rationing and delivery of care based on need. And where this was most shown was around vaccination.

We were actually prioritizing postal codes to get access to a very important medication. And that's a really important opportunity, where you can start to see not-- it's not solving an issue, but you can start to see people starting to look at those people who don't get access and putting them at the front of the line. And that's something that we need to continue to work on.

And so there's no doubt that what the pandemic did was illuminate the fractures of the system. What you're hearing from everybody-- and it's actually-- you almost hear it in harmony. There is an important thing in Canada around caring for people. There are better models. And now is the time to actually not to say what we don't want, the US, but to say what we want.

Number two, it is not a universal system. Those people, for socioeconomic, racialization issues or other, don't get the same access. So we have to not be comforted that we have a universal system. We don't. And there are things to be built upon that are bright lights. But we actually now need to have some hard conversations.

And the final piece, which I hope we get a chance to talk about, is health care is 12% of GDP in Canada. That's $200 billion. That's US dollars. And actually, there's a tremendous opportunity to create prosperity for companies and other groups that come into it, not necessarily on a delivery side, but even technology companies. There's prosperity. Health and the economy have always been linked. And now we're at an opportunity to have an honest, real conversation about where to go. So thank you so much for bringing us all together.

CARLY WEEKS: That's really great. Dante, thank you for that. And we're going to be, I guess, going into this next round talking about some of the solutions. So everyone get your answers ready for that. And I know that there are so many-- as you say, there's a lot of harmony here, maybe some different ideas on how we do arrive at that better system.

I'll turn things back to Katharine right now and just ask some of the things that you think we really need to-- expanding, if you will, on some of what your previous answer was, on what we really need to do and focus on, sort of on that ground floor level. How do we get that change? We're talking about capacity issues and more beds.

And do we bring in private care? It's so complicated. I wonder if you can simplify this for us, boil it down. What do we really need to do to achieve a better system where people aren't waiting and aren't at the back of the line and postal codes don't determine your health care access?

KATHARINE SMART: Thanks, Carly. So a few thoughts-- it's obviously a lot there, but I'll try to break it down to some of the levels of health care, where things happen and what we could think about. So the foundation of our health care system is primary care and community access to preventative care and management of chronic disease. And that's done by family doctors and other community-based health care providers, who work throughout the country providing that care.

We need to make sure that that care is available to everybody. There's excellent evidence that good primary care prevents a lot of disease down the road. It allows us to optimize people living with chronic disease. And that saves costs downstream in the health care system, prevents people from being hospitalized, and gives people a better quality of life.

So recognizing that, we need to really understand why that system is no longer working. And I think there's many structural reasons for that. A lot of times, we think we don't have private health care in Canada. But in a lot of ways, we do. What we have as a universal insurance system.

We have care privately delivered by physicians in communities who fund the infrastructure of that through their fee-for-service billings. So I think if we start examining that and go, OK, is that then the best model, does fee-for-service medicine incentivize what we want, I think most new doctors and most physicians now entering into primary care would tell you it doesn't. It incentivizes volume.

It doesn't necessarily incentivize patient-centered care. It doesn't incentivize time for people with complex issues. And I think any patient who's been to the doctor where they've only been allowed to talk about one problem would say it's also not the best way to respect people's time when they're accessing care. So I think we need to look at that for what it is and understand that we need a different structure there.

We need more support for the infrastructure of community-based care. We need different models of payment to allow for integrated team-based care, where physicians can be focused on being more patient-centric, working with a team of health care professionals to get their patients the best quality of care, and also find the joy in their work that will keep them in primary care. Physicians are in medicine because they want to care for patients. And we need to have systems that allow for that.

And once those are well-designed, then we can be doing a better job at addressing the equity issues because we can recruit and retain health care professionals across our communities. Right now, that's not what's happening. So I think some of those structural changes to the way primary care is organized and delivered would go a long ways to solving there.

When we're talking about the secondary level of care, access to specialists, medical specialists, surgical specialists, that's where there's definitely things we could be doing differently-- centralized intake systems so that we actually are making sure people are getting to the specialist who's next available, better leveraging of virtual care so that different specialists in different areas can be providing care more broadly to the population, limiting unnecessary medical travel for Canadians living in rural and remote communities, like where I am here in the Yukon. Those things can all improve access and decrease costs, be more environmentally friendly, and make better use of patients' time.

I think in the hospital side, we need to make sure we're optimizing that very expensive resource by improving access to things like publicly-funded long-term care and home care services. Having patients staying in hospital when they could be at home in the community, what we're hearing from aging Canadians is they want to age in place. They want access to home care. That is much less expensive so there's the benefit there.

People are getting what they want. Their dignity is being respected. And we're then freeing up that very expensive resource of the hospital for people that are ill and need that type of care, and for people that need to have surgery and need to be in hospital post. So we need to look at how we are utilizing our systems. We need to use data so that we're actually tracking what this is doing, we can be sure we're getting the outcomes for our investments, and also giving feedback to the system about what's working, where is the waste, and where can we do better.

CARLY WEEKS: Thank you so much for that. Cheryl, I'll go to you next because I wanted to see if you could build on that or just reflect on how that-- some of those calls for structural change could impact your community. Are those in line with some of the things you're thinking about in terms of building on those solutions, changing the system for the better?

CHERYL PRESCOD: Absolutely. I think I really resonate with what Katharine just said. But I think-- let me start with addressing the social determinants of health, for example. Let's have some upstream interventions. Let's focus on incentivizing health care organizations that really address social determinants of poor health.

Let's go back to Patrick. Patrick, who is a Black male working in an essential job, also has type 2 diabetes but cannot afford to buy his insulin. So what could it take for us to actually address Patrick's issues, maybe in an upstream way, before he falls over the cliff and ends up in the hospital bed? There are so many things that we can do.

We can address things like food security, such as proper housing and infrastructure, so that folks can exercise and really address their needs, and also have a pharmacare system where people can afford to buy those medications that they so desperately need and many cannot afford. So it's, I think-- again, as a community health center, we do this. And we also work in a team-based model with salaried clinical providers, who are able to take the time with patients like Patrick to help counsel him and refer him to an in-house dietician and diabetes educator, to help him understand how he can manage his disease.

So I think there's just so many benefits to all of-- I think we're all on the same page-- and to help him stay at home and live well. Let's see. So again, but it has to be a model that's salaried and supported and incentivized to really address those social determinants of health. It's not only a model that incentivizes us on volumes of care. It's around, as well, our outcomes.

In the community, what is your outcome? And we also have to-- again, because social determinants of health is such a precursor of ill health, we also have to think about how we can coordinate care across systems. So the public health system, for example, that's something that we know public health initiatives have-- are known to prevent diseases and known to prevent death, initiatives such as stop smoking and wearing seat belts that really decreases the rate of deaths among individuals of populations, we know that there are strategies that collectively we can come up with that will decrease the poor health outcomes of many out there.

So again, as you said earlier, Carly, the postal code that you live in should not determine whether you're a hotspot for any infectious disease. And this is what's happening. And I think if we don't want to go down this road again, we do have to think about correcting those cracks and patching those cracks that were found through COVID. We have to.

We're still battling chronic diseases like diabetes in these communities, sexually transmitted diseases, HIV. We still haven't solved a lot of those problems in certain communities. In other communities where we're more socioeconomically advantaged, certainly, people are doing better. But in these communities, there is no excuse for what's happening in Canada, where we have these universal health care systems, which I think is arguable as well.

CARLY WEEKS: Definitely. And I think that, hopefully, this is why events like these can hopefully help shine a light on some of those issues. And because there are, I think, so many people out there who just simply don't or are not aware of the disparity and discrepancies there that do exist. Craig, I'd like to bring you into the chat and just get your perspective.

We often have so many policy discussions and things of what to do with health care, without necessarily bringing in the caregivers and the people who have that firsthand experience. So what changes from your perspective? What were the things that really made it so hard that made you lose trust? And what changes, concrete things could have been done, simple things, to make it a better experience?

CRAIG CONOLEY: I know that with my mother with stage four brain cancer, there was a lot of lack of resources around aphasia and learning how to communicate with her. A lot of it was left to our own responsibility. That was very hard. And I think, due to shortages, staff-patient ratios, and wait times, there's such a high rotation of nurses in acute care facilities that there was never a familiar face, it felt like. There was always a new nurse.

And I really feel for the nurses and the doctors. I really care for them. They need to be supported. And a lot of the problems like burnout and issues we face in the care, I think, had to do with such a high rotation of nurses in those settings. Simple things-- what happens when the buttons on the outside of these institutions, those disability buttons that open doors for people with physical mobility don't work? It's a small thing, but what does that say? There were many, many, many instances of struggle, so yeah.

CARLY WEEKS: Thank you for sharing some of those. And I think you're right. And you're not the first person who's has even brought up just the accessibility issues in conversations about the little things that really can impact-- like someone in a previous interview I did was mentioning how chairs in the waiting room didn't have arms. And it was impossible for their loved one to actually sit in a chair in the waiting room. And they ended up having to leave. So the little things are really important and do make a difference.

Dante, I was wondering if you could also share some ideas you had for solutions. And I know specifically there's initiatives that you've been working on to try and bring about some really meaningful change. I was wondering if you could talk a little bit about that and what kind of impact that is having.

DANTE MORRA: Thanks, Carly. And I'm going to-- I'll answer your question. I'll just go back a level, one level. And that is, what you're hearing universally from people is that there has to be really a big adult conversation of how we spend that 70% of spend. So you heard early on from the economic side, some groups spend 75% public, some 70% of their spend in health care. The first conversation has to be, what's the most rational way that we spend a universal system?

And how do we drive that change through organizations to care for our public in the most rational way? And where that breaks down is when the money that should go to disadvantaged individuals goes to advantaged individuals. I'll give an example of that. So if you actually look at family health teams-- I'll take an Ontario lens of this, but team-based care-- when you really look at who's rostered in those teams, they're often advantaged people. So you have rich models caring for rich people. And so that's a bad use of universal dollars. And that's not because anybody's bad. It's just that the economics describe that.

So where you start to get good models-- I'll give an example of that-- are around integrated or bundled payments. So I think-- because sometimes you get into these conversations, and it starts to become almost overwhelming. Because people say, well, what about this, what about this, what about this? Step one is, what's the most-- the best way to spend our universal dollars? Step two, let's copy somebody who's better than us. Let's just have an adult conversation and say, we're not the best, we're going to copy somebody. And then step three is we actually have to have some hard conversations about choice because choice is important.

So an example of a good solution, bundled care or integrated funding-- and I'll use our cardiac PPAC program at Trillium as an example, because I was involved in that, which won a quality medal at the provincial level. What we did is, instead of a patient getting cardiac surgery, then getting home care that was detached through some organization, we bundled the payment. We said, give us the money for the full 30 days. And so what we did is we partnered in such a way so that the money came, and the cardiac surgeon and the home care person were at the bedside.

When the patient left, it wasn't a mystery who was going to show up. It was all integrated with cost savings. So what we were able to show is the patient experience was way better. They knew who to call. And when the home care person was there, they could talk to the cardiac surgeon. They all knew each other.

The second thing, you got better outcomes. Fewer people came to the emerg, less infections. If there was an infection, it got caught earlier. That's amazing. And the funny thing is it cost a lot less. When you align the funding and the delivery in the right way, it can be done. And by the way, we copied that program after other hospitals. So you don't have to-- these aren't inventions. They just need to be scaled out.

But we also need to also have some real conversations. Like I'm a physician. Every provider does want to do right. But they're economic beings as well. You have to realize that. Should a psychiatrist get paid 1/10 an ophthalmologist? No, they shouldn't. Should we be producing more orthopedic surgeons or should we be producing more psychiatrists? So we actually do have to have an adult conversation about how we're using our HR supply and how we're funding people to do that so that they're actually directing their labor in the right way.

And on the patient side, there's a hard conversation we have to have about choice. Should somebody in a hospital bed actually be able to determine what nursing home to go to and block a patient in the emerg to get in that hospital bed? Now, you want that person to have a choice because you don't want them to go to a nursing home too far away from their loved one.

But is that the best use of that bed at that point? And does that choice get to trump the person who can't get into the bed? So at every level, what we actually have to do is be very honest about what's not working within the system. And then I'm happy to talk a little bit more about how can you direct the talent of Canada to solve some of these problems so that the jobs stay in Canada. Because again, somebody needs to pay for the system. It's actually all linked.

CARLY WEEKS: Thank you for that. And I think we'll leave some of the talking about Canadian talent toward the end. We'll end things on maybe an optimistic note before we get into some questions. And just a reminder, there are some great questions coming in. We're going to get to them. And if you do have one, please submit that.

So Dr. Smart-- or Katharine, sorry, we're on first names today. I thought I would ask your perspective on that. What you just heard, as someone who also has perspective and experience within the health care system, are these the kinds of things that can work, scaling of these kinds of models? And if so, how do we just not do that faster and quicker and get it done for everybody?

KATHARINE SMART: No, absolutely. I think what Dante was talking about is so important. It's really about tying the funding to the patient and their experience and the outcomes we're seeking for the patient, rather than these global budgets that, in a lot of ways, disincentivize care. In that context, when there's a certain amount of dollars assigned to the patient, it then motivates the facility and all the people involved in providing that care to make sure that they're using those dollars efficiently to get the outcome that they want and that the patient wants. And we're very aligned there. So I think that's, again, this concept of linking outcomes and accountability to funding.

And that's one of the big problems in our system, is we don't always do that well. So I think taking some of those ideas and scaling them make a lot of sense. And this is also why we really need to improve our data infrastructure in health care with interoperability, between electronic medical records and where this information lives, so that we can be tracking how we're doing.

Without data, it's very hard to know the quality of care that's being provided, what places are doing it well, what places aren't. And like Dante said, this isn't about new inventions. It's about scaling things we know work, and then monitoring how we're doing, making changes, and then advancing on things that are working well. But we need information to understand that and to be able to make those decisions.

CARLY WEEKS: Definitely. And Cheryl, you were mentioning how just so many people in your community, it's almost like they've been kind of forgotten by the system. It's just so much harder. And we heard Dante reflecting on how the system-- health teams, for instance, are serving the rich instead of the marginalized communities where they're needed. Do you think that these kinds of incentives, this kind of model, is this the way forward? And in addition to that, I guess I would also add how you can see community health centers playing an even greater role in making sure that care is delivered where it's needed.

CHERYL PRESCOD: Certainly, I do see community health centers, community family health teams, all of these team-based models being instrumental in helping to address these issues. Because what we do is we really look at the health of a community because we have to do population-based planning. Not all population groups are the same.

We have to really do a deep dive into using data. Because definitely, we need the evidence that, so we have to-- we cannot stop collecting data and to really inform how we deliver services. What is it that we need to do? We have a lot of work to rebuild the trust in some of these marginalized communities.

Because it's not just about going to the doctor or the hospital. There are many folks who will-- the trust in the health care system is so eroded that they will not go to the hospital before things get so catastrophic that they have to be admitted. So I think there's-- again, I'm going to go back to my upstream argument, where we have to do a lot of work with people in the prevention and trust-building, confidence-building in our system. Because once we do that, we're able to change health behaviors. That may mitigate those visits to the specialists and to the hospital.

So I have to come from it from that perspective because I saw it play out in the COVID vaccine rollouts, testing rollouts, where it's the boots on the ground. It's the people in the communities that really encouraged those healthy behaviors and really helped to stop the spread. And this is what we need to do again for transmissible diseases, number one, but also for those chronic conditions that can be managed, and to prevent visits to the hospital.

And we do know that these team-based models, where people have access to a variety of support, they're able to engage with patients, or clients as we call them in the community, and help to mitigate some of these more serious health conditions. Preventative screenings, for example, so that we're catching things like cancers a little earlier and they can be addressed earlier rather than later. And it's all-- it is-- I think, ultimately, I do know that we have to think about dollars.

But how are we managing those dollars, and how are we accounting for those dollars? Is it about the number of visits to a hospital, the number of beds that are occupied? We have to get away from that. We have to come back to, how many folks are we preventing from entering the hospitals, actually, and from the community-based models that we have?

CARLY WEEKS: Yeah, that's a great point and just that whole idea of incentivizing care around what patients need and when they need it instead of, yeah, visits and things like that. Craig, we're going to do some questions in a second. We have lots of questions, and the first one is for you. But I promised Dante.

I wanted to end the formal discussion part on an optimistic note. And so I heard things about keeping Canadian talent here and leveraging some of the great work that's going on in Canada to bring about some of those system improvements. So I was wondering if you could just talk briefly about those before we get to the growing list of audience questions.

DANTE MORRA: Thank you. And I think, actually, it's a really great optimistic time because when you get everyone framing the issues together, there's amazing hope. And I think-- I hope our audience can almost hear almost like a harmony of framing, and now there's an opportunity. On the other side, so when you look at the business of health care, and people will say, OK, there's AI coming into health care, or there's technology coming in, the delivery of health care, there's large supply chains.

There's things that we build. There's things that we operate. Canada has an amazing talent of R&D and people. And the jobs actually can stay in Canada. And these great companies can stay in Canada. And the solutions can come here.

I'll give an example. CANInmunize, great Ottawa-based company that created software for immunization. The Nova Scotia Health Authority used them during their vaccination center. And that actual technology was better than the sales force that came out of the US. And Nova Scotia had one of the best vaccination programs, even globally. That company then employs Canadians and builds more capacity to then solve other problems.

Same thing, Precision ADM out in Manitoba that created recyclable masks bought by the Manitoba shared services that scaled across Canada that improves our supply chain. The solutions, right now, if any of you listeners or people remember Blockbuster Video, you go to Blockbuster. You'd be like, I need to find a video. The video wasn't rewinded. You got late fees.

We had a certain model, and Netflix came along and changed that. Health care is changing rapidly. And the question is, who do you want to be the people who change health care? It's us. Our great Canadian companies can win. They can solve our problems. They can turn into global winners. Those jobs can stay in Canada.

And that can actually power our universal system in perpetuity. That's happening right now. It's something that we call Can Help. It's about bringing the country together and using the system to scale technology and drive prosperity. That Precision ADM has 200 jobs in Manitoba. Those are high-paying precision manufacturing jobs that now pay into the tax base for that universal system.

So I think there's a moment. Health and the economy has always been linked. COVID showed us that more than ever. And it showed how it actually can make it more disparate as well. The winners can win more. The losers or the people who are not advantaged can be more disadvantaged. But actually, there's an amazing moment by bringing the 40 million people of Canada together, by choosing what is truly universal and doing that well, by copying what is an opportunity that others do better, and spreading, as Katharine mentioned, the things that work-- no more pilots. And actually using the economic power of our talent to solve our problems, there's a great future going for us.

CARLY WEEKS: Well, that's the optimistic note we were looking for, so thank you for delivering there. But certainly, yeah, there's lots of exciting things happening in that space. We could fill a whole other panel with that.

There is a lot of questions for you guys so I wanted to jump right in and get to some of them. And the first one is for Craig. And I think it's one that a lot of people have been thinking about during the pandemic. So from your perspective, how could home care be improved? Just reflecting on your experiences as a caregiver and just things that you've witnessed, what do we need to do?

CRAIG CONOLEY: Well, I think that during the last two years, we've seen that unpaid caregivers continue to play a crucial role for adults living in Canada and others needing instrumental help with activities of daily living. I do think that we're-- my generation is the hidden backbone of the health care economy, in fact. And if we're not supported to thrive versus solely survive or merely exist, the resulting systemic backlog could bring the system to its knees.

And because we're talking today about strategic partnerships, I do want to note that the partnerships between unpaid caregivers and the health care teams were severed due to COVID visitation restrictions. So I think that caregivers need to be invited into the team dynamic in an authentic way in order to learn about hands-on care alongside staff in hospitals. Because we are the ones who are going to be delivering this care in community.

And I also think that this will impact hospital readmission rates, especially if we do it right the first time. And then on a positive note in thinking about solutions, which will inevitably help home care, I think the media has an important role to play in spotlighting caregiving stories. We need to see the experiences.

We need to feel them, hear them. We need to know what's coming. And so if it's CBC or if it's investigative reporting or if it's documentary work, millennials really respond to this kind of content. I also think that education has a role to play.

I had this wonderful idea where-- co-op placements in high school were a thing. What if we had care placements? What if we started thinking along those lines? Those are just two ideas that I have.

But yeah, I think also really important and lastly is we live in a culture where we regard death in a certain way. We speak about death in a certain way. I think that we need to think about quality of death in our system, in our health system, and try to create a context where a patient can actually have a good death, which is something that I know my mother, unfortunately, I don't think had. So those are just some thoughts.

CARLY WEEKS: Thank you, Craig. And I think those reflections really resonate. And to your point about death, it's very true. And it's something that survey after survey shows can Canadians want to die one way, and at home, maybe with loved ones. That doesn't happen in many cases. So there's a lot of things that can be done in that space.

And anyway, just thank you for your advocacy work in this area. We'll come back. We have more questions. And one of them I wanted to get, probably Katharine and Dante will have the most to say about this.

But basically, looking at what we talked about earlier about the private model and the idea of opening up our system to competition, to really embracing more of the public-private split, we did address this already by saying we do have a lot more private care than people realize. But I wanted to just to get your thoughts on-- maybe Katharine can start us off in this, and then if Dante wants to chime in and anyone else. Does the private sector have a greater role to play? What can they help with? What areas would be a natural fit if we were to go down that road?

KATHARINE SMART: I think what we think about when we talk about private care in Canada is often an American style health care system, which we know is not an example of a health care system we want to emulate. But we do have examples in Canada, where there are private delivery of publicly-funded services that work well. And that would be-- an example of that would be your family doctor's clinic. That is a publicly-funded clinic, but it's privately delivered by the physician who's running that infrastructure.

So I think, first of all, we need to understand what we're already doing, what goes well there. Physicians are generally quite efficient at running offices and have a lot of experience in creating that community infrastructure. But they could likely use more support from governments to be able to move that, shift that more to the community care models that we've been hearing about, more of the integrated team models.

So I think there are opportunities there. We've also seen some ability to create more capacity by moving surgeries, for example, out of hospitals into other facilities, surgeries that are day procedures that don't need all the resources of a hospital, where patients can receive that care. And that can help to lessen that load. But again, what we're talking about there is publicly-funded procedures happening in different environments, versus that two-tiered system that has really significant equity concerns.

So I think we have to be careful that we don't let that conversation derail by assuming what we're talking about is creating sort of a market for health care, which I don't think is really what we're meaning. But really what we're thinking about is what things can we leverage, where can we partner, where can we find efficiencies, where can we deliver better value for Canadians, while keeping equity as a key driver. And in that way, it means that those things do need to be publicly funded so that we're not creating a two-tier health care system. But I think we need to be having the right conversations and not be afraid to talk about what's needed to create the change.

[AUDIO OUT]

DANTE MORRA: And so we continue to perpetuate the current status quo. And I think this conversation is illuminated-- look, there's things that we can do. And we have to actually call the baby ugly a little bit and move on. So I think that's risk number one.

The second biggest risk-- because it's actually not hard to know who to copy, right? Just, let's copy Australia. OK, done. Like it's-- you're not going to copy Denmark because it's not the same type of population. Or Sweden, it's 5 million people. But there are groups that we can copy. And copying and fast following is always a good idea.

The biggest issue right now is labor and the ability to have the labor to actually do the work. Because if you start to create parallel models of surgical delivery, as well, you can start to take nurses out of the OR of hospitals, where they're actually having difficulty. And that actually can make the system worse. So what we actually need to agree-- and the nursing shortage that happened during the pandemic is like all the cracks.

Everybody knew it was coming. It's just now everybody can see it. So the reality is we actually have to decide, how many nurses do we want do we need, and produce enough in Canada, not to steal them from other countries that probably need them even more, but actually produce enough of the light labor source for the market. As an example, don't leave it up to a university to decide what type of doctors they're going to produce. Because they'll create a certain number of orthopedic surgeons, a certain number of general surgeons.

Actually say, this is what we need. Let's produce enough nurses. Let's produce enough social workers. Let's-- we control the admissions processes of these spots. We pay for it. So we can match supply to demand. It's not going to be perfect. It's a market.

But the reality is that that's going to help us four years from now. And there are ways of recruiting and retaining Canadians and bringing new Canadians in. But there's a certain ethical lens of that as well. But the human resource supply, let's figure out what we need. We fund it. We already fund those spots. Let's allocate the right amount.

And that allows us the ability then to transform into new models. It's actually not as complicated as people make it out to be. You've got to be willing to take some of the power away from decision-makers who are satisfied with the current status quo. Often around health care, there's an industrial complex between physicians, labor, and the people who run the system. Patients are often outside of that. That industrial complex maintains the status quo. And so you just have to understand the politics of that.

CARLY WEEKS: That's actually a really great explanation. You took a huge issue and you were-- thank you for simplifying that because I think that's-- a lot of the questions that are coming in are kind of going about that in various ways, the idea that we spend so much and our capacity is so terrible. And how do we fix that?

This is one thing that perhaps Craig can reflect on, and then others want to jump in. We're having some technical issues with Cheryl. We think she might still be here. So we'll just-- if Cheryl wants to chime in after-- I think-- OK, I think she is there.

CHERYL PRESCOD: I am.

CARLY WEEKS: So Cheryl, I'll get you maybe to jump in too. OK, great. So Craig, when we talk about coordinating care-- and that's one of the things that has emerged. We need a system that's going to follow patients around. Just your perspective, how could that have made the difference for you?

You said that you've lost trust in the system. You dread going back to it. That's obviously terrible. It's tragic when that happens. And it happens all the time. So what are the kinds of things that could help with better coordination of care? And then Cheryl, perhaps when he's done, you can jump in on that as well.

CRAIG CONOLEY: Yeah, I think that Ontario health teams and caregivers really have an opportunity to team up. And I think that during COVID, there were moments where I was providing care in community and couldn't have access, couldn't have people come into the home. So I think that if these pandemic realities, they continue, we need to really find a way to get care in the home and supported.

Mobility, transportation, administration of medicine, these are all things that I had to do. And they were very difficult, especially when it comes to physical mobility support and hygiene care. Unfortunately, some of these things are pretty-- these resources are thin and unreliable. So I do think we need to bolster the Ontario health teams and really strengthen that relationship with caregivers.

CARLY WEEKS: Cheryl, your thoughts on that as well.

CHERYL PRESCOD: Hi, there, so sorry about the camera. I'm trying to figure that out. But I did want to go back a bit to the previous question because I also wanted to bring up the point about scope of practice within our health care system. When we talk about the system, we very much talk about physicians.

And I really want to acknowledge the work of nurses and nurse practitioners and RPNs within our system, especially throughout the COVID pandemic. They played such an integral role. And I do think that part of our health care planning needs to really ensure that we think of how best to utilize and maximize the scope of practice of these professional groups because they do-- they can do so much.

So I just wanted to-- as well as, again, coming from the community sector, the work of community health workers, who are so integral to connecting with our communities, building trust in the communities, and really helping patients navigate our very, at times, complicated systems. And I do think of folks that are newcomers to the country that don't understand the health care system and get caught up. And they get stuck, and they fall through the cracks, or folks that do not speak English as a first language. We really have to think of all of these elements of our system that contributes to good health and getting them to the right place at the right time and get them the care that they truly deserve.

And to going back to from a patient perspective, we hear so many stories of folks who just don't understand the system, don't have supports at home. Even though home care may be available, it's just never enough. It's never appropriate at times. The cultural elements are not there that are needed for really good comprehensive care. So I do think that language, education, navigation, all of these things are integral. We just can't talk about health care without thinking of those other social determinants as well.

CARLY WEEKS: Yeah, that's so important, Cheryl. And just to that--

[AUDIO OUT]

--advocacy. And how well you can advocate for yourself will often determine your health and your access to the health care system, so obviously, not a very good situation. Just to build on that point that you had just raised-- a question did come in, as someone just noting the panel discussing the disconnect between frontline health care workers and the people who are making decisions about the health care system. So what can be done to bridge that gap, to really drive home that point about why we need to start caring more about social determinants of health and paying attention to the needs of communities, all throughout our geographic areas?

KATHARINE SMART: Can I make some comments on that, Carly?

CARLY WEEKS: Oh, yes. Yeah, please, go ahead.

KATHARINE SMART: Thanks. I think what Cheryl's been saying is so important. The social determinants of health are so critical. And in my clinical work, I'm a pediatrician. And we're learning more and more about how adverse childhood experiences impact the health of adults. It's a major driver of both physical illness and mental illness.

So we need to have better policies that are supporting families and young children to optimize development. We need to be addressing things like poverty that lead to bad health outcomes so that we are keeping people healthy. I often say, again, what we have is an illness system, not really a health system. So we do need to be thinking about what creates health.

And I think another big theme you've been hearing today is just the lack of integration. And to Dante's point, we do not have a human health resource strategy in this country. And a human health resource strategy absolutely needs to look at not just doctors and nurses, but about all the health people we've been talking about today-- community health workers, families as caregivers, as we've been hearing from Craig, home care.

We need to really look at-- if we have it our ideal model, who do we need as those human health resources within that model. And then we need to make sure that we're integrating across the system, including our educational institutions, to be providing the supply there. But right now, those things are not connected.

We don't talk to each other. We don't make those plans collaboratively. So we end up with this sort of random assortment of people, not always in the right areas, not always in the right locations. And that doesn't allow us to sort of have that integration right from that social determinants upstream lens of prevention.

And how do we create health right through into the health care system, and who do we need where, and at what numbers to make sure that people are getting the access that they need? So I think if we can start to really move towards that collaboration, that integration, with that overarching model of what it is we're trying to achieve, I think we can get a lot further to where we need to be.

CARLY WEEKS: Thank you for that. And Cheryl, I'd ask you to jump in, as well, just any thoughts you have on that, just about the-- because I feel like that's something that is a question that must come up for you time and time again.

CHERYL PRESCOD: Again, I think in order to really address population health, we really have to get to know our population. And we have to, again, rely on data and evidence. So I know that during the pandemic, we really emphasized the need to do that in Canada. A lot of what we learned early was from the UK or the US.

And I do think that we do not do it very well. And we have to figure out, how can we plan better by getting the evidence, the data that we need? Data, in a way, that's segregated in such a way that we understand what's happening in certain communities and population groups.

Let's not-- I think someone said it earlier. We have to have some tough conversations, courageous conversations where we talk about race. We have to talk about people living in poverty and realize that we are amongst-- these are Canadians. They're fellow Canadians. And for us, for one of us to be well and this country to be well, we all have to be well. We cannot leave anyone behind. We have to take care of everybody that's here across our country.

CARLY WEEKS: Thank you for that, Cheryl. We're just a couple of minutes from wrapping up. And just thank you everyone so much for contributing. I wanted to do one last go-around. And I'll start with Craig, and ask everyone the same question. And feel free to take it in whatever direction you see fit. But it kind of riffs off what someone had submitted. And this is basically-- are we at a moment in time where politicians and bureaucrats, are they motivated to make those changes that we need? And what would be your message to them about why this is so urgent, actual change, actual reform? Craig, you're up.

CRAIG CONOLEY: Yeah, that's a big question. But I like it. I like it a lot. Well, I've taken some time to read the letters of appointment from the PM to our health ministers. I've-- from my experience, I feel like some of these things have not been followed through on. And for me, I think having that transparency and being able to document, potentially, care, suboptimal care, it's important that we are able to do that for our family members who can't advocate for themselves, especially those with aphasia.

And it's not about pointing out specific people or institutions, but calling out systemic problems and barriers to quality of care. And I think this data, being able to document subpar care in the context of your mother or father, I think that kind of data will really help physicians who are also advocating for better quality of care conditions in the workplace. And that's just one final thought that I had.

CARLY WEEKS: Thank you. Thank you so much, Craig. Dante, your turn, huge question, and you have like 30 seconds to answer.

DANTE MORRA: Yeah, I think first of all, politics and politicians, it's a tough job because there's many different voices that you're trying to manage. But they follow the people. And I think the reality is that we're at a special moment, where I believe that you won't get a singular voice like you do with the Olympics, where everyone is cheering. But there are moments where people can come together and agree.

And I do believe we're at a moment where we can agree on what's not working, and we can agree on some things that work better elsewhere. And I think that's a great place to start. And then also, there can be an agreement on what's the right amount of public dollars and how to spend that the best way.

Community health workers may be the best dollar per dollar use of health care dollars and the best use of a primary care model. Let's actually have that conversation. But let's actually agree on how much we're going to spend.

Competition is really important. So you could go often to get your teeth cleaned at a dentist's office, but you couldn't get into your doctor's office. It's actually-- that's interesting. So there's-- competition in models, actually, can be helpful. And they can lean out processes. And they can bring capital in new ways.

And so I think we are at a really important moment. And we have to actually decide some tough things. Are we-- has Canada decided to pay for a long-term care? Is that part of the Canada Health Act?

And so there's-- but we actually have to put these issues in the storefront and not bundle them all up as a private and public system, and take them one by one by one in a rational way. And I do think we're at a really unique moment. Canada is a great country. It's taken care of its people in the best way that it could.

And there's a lot of positives that happened in COVID. And there's a lot of realizations. And what Cheryl said is, what COVID did teach us is you can't hide. The public health is-- we're all together. And so let's take that energy and unify it and come up with some really tangible next steps and solutions. And I do think the political environment will follow the people as we move forward.

CARLY WEEKS: Thank you for that, very, very nice summary. Cheryl, I'll turn it to you.

CHERYL PRESCOD: I think, again, lessons from COVID, terrible, terrible time for everyone, but also the lessons learned. And I'd really like us to move forward with those lessons. And I think the public, in general, have-- they're more in tune with their health. They're more in-- everyone is now a scientist and understands about vaccines.

So I do think that we have to grasp that opportunity and help ensure that the voice that people now have, especially in marginalized communities, is amplified. So to the previous point around advocacy, how do we connect the decision-makers with what's actually playing out on the ground with health care is we have to start listening. We have to start listening I know that in our community, we have really engaged with folks who have previously been disengaged around their health.

And they now want the care they deserve. And I hope and pray that we can do that as a collective. We can't do it alone. We have to work with our partners in public health. We have to work with our physicians and hospitals. We have to work with each other, as well as those caregivers.

We have to remember what's happening in our homes and ensure that we support everyone. So I do think that I'm hopeful that, in partnership with everyone that we serve-- we are all patients. I'm a patient at times. And I'm a caregiver as well. And we have to ensure that we just-- we have that empathy that we all should have in health care.

CARLY WEEKS: Thank you, Cheryl, very nicely put. Katharine, I'll give you the last word.

KATHARINE SMART: Thank you. So I think right now we're at a pivotal moment where we need to own this problem collectively, with our leaders in politics, with our leaders in health care across health care professions, and with our patients who we're here ultimately to serve, and community. I think we're at a point where we all agree what we have is broken. More of the same, the status quo is not working.

So let's own that together, and let's start moving towards those solutions. And let's make sure as we engage in those solutions we have the right people at the table, the people that deliver the health care, the people that are impacted by how the health care is delivered, creating these solutions. Let's leverage the things we know work in other places. Let's get towards that action.

Let's not be blocked by our commitment to the sort of status quo or our fantasies about what we think our health care system is. Let's get serious. Let's move towards systems transformation. And let's do it so that all Canadians have that chance to be healthy. We can really be serious when we talk about equity. We can recognize that we need to create health and prosperity and have a health care system that's ready to deliver. And I think we can get there. I think it just needs us to get there together.

CARLY WEEKS: That's a great message. Thank you so much for that. Thank you, everyone, for being part of this today, to everyone watching and submitting questions. Lots of interesting-- we didn't get to all of them, but we do appreciate the interest. And thank you to The Globe and Mail and to the Canadian Medical Association for partnering with us on this event.

For those of you who are here, we're going to be sending a link to the webcast. So you can share that, watch it again. And I just wanted to say thank you all for being here and taking part of this really important discussion.

KATHARINE SMART: Thank you.

[MUSIC PLAYING]