Many thanks to Liberal Leader Justin Trudeau and his staff for sitting down with us to discuss the urgent need to improve seniors care in Canada. Mr. Trudeau has committed to calling a First Ministers’ conference should his party be elected to government, and he agreed that seniors care is too important not to be on the agenda.
On Tuesday this week, it was my great privilege to address members of the Canadian Club of Ottawa at the Chateau Laurier in Ottawa. Thank you to Shannon Day Newman and the other members of the Board of Directors for inviting me to share my ideas.
My message was that we need to address seniors care in this country. The reason? Well…. if we can fix seniors care, we will go a long way to fixing the health care system in Canada.
Today, seniors use about 45% of all the health care dollars spent in Canada. With the seniors population set to double over the next 15 years (and the 85+ population set to quadruple!) it’s not hard to do the math and realize that we are in big trouble unless we figure out how to do things very differently.
Here is the essence of the problem: Canada’s health care system was designed in the 1960s, when the average age of Canadians was 27. The health care landscape was one of acute disease. You got sick, you went to hospital, you got better, and you carried on.
Today, though, things are different. The average age is now 47. And the health care landscape is increasingly one of chronic disease. Diseases like arthritis, heart failure, chronic obstructive lung disease, heart failure, dementia, and diabetes; to name just a few.
Canadians’ health care problems are very different now, compared to 1960. But our health care system is still the same. It is too much about hospitals. We have a hospital-centric health care system.
I started my talk by telling the audience about “Code Gridlock“. (Click here for a written transcript of the Canadian Club Speech).
At my hospital, Kingston General, we have made incredible improvements over the past 5 years. We have examined our processes carefully and have become extremely efficient. We balance our budget. Every dollar spent is subjected to incredible scrutiny. We have made tough decisions. Our doctors and nurses and other health care professionals are outstanding. Our leadership team is lean. We have won national and international awards for our organizational excellence; particularly our focus on patient and family-centred care. We are all proud to work here.
But, in October, we spent 18 days in gridlock.
And today, Nov 19, 2014, we are in our 26th consecutive day of gridlock.
What does gridlock mean?
“Code Gridlock” was devised as a means to recognize that the hospital is so full with patients that patient flow has ground to a halt. The Emergency Department is packed to the gills. Elective surgeries are cancelled. Patients in partner community hospitals, who need to come for tertiary level services, just have to wait longer. The leadership team – usually focused on strategic goals, participates in an “all hands on deck” approach to problem solving – not inappropriately. The intent of “Code Gridlock” is to compel everyone – nurses, doctors, housekeepers, administrators – to go “above and beyond” to get patients safely discharged so we can get our new patients in.
A very reasonable strategy for a rare occurrence.
But here’s the problem: Its not a rare occurrence anymore. It is the new normal.
So what do we do?
The answers are not simple. But all the smart money is on the development of a national seniors strategy.
We need to find ways to better and increasingly serve our seniors – particularly those with chronic and not acute disease – in non-hospital settings: home support, community-based solutions, and quality, safe long term care facilities.
About fifteen percent of all acute care hospital beds in Canada are occupied by ALC (alternate level of care) patients – patients who are not acutely ill but who have no where else to go). We are warehousing these seniors in hospital beds – where they are more likely to suffer falls, to develop hospital-acquired infections, and to decondition. They should be in an environment that lifts them up, and restores. them; that allows them to live a dignified life.
A national strategy for seniors – that encompasses the full continuum of health care as well as determinants of health like housing, poverty, and the contributions of families – is the way forward. The federal government needs to be at the table.
————-Ottawa Citizen Story—————
—————-CBC Ottawa Story—————–
Is it unreasonable to expect our political leadership at the federal and provincial levels to sit down together to plan how we are going to address this huge problem that threatens to undermine the sustainability of the health care system in Canada?
Voters – challenge your federal candidates. Is their party committed to the development of a national seniors strategy? Mark your ballots accordingly.
(Above) With pollster Nik Nanos and Queen’s University Chancellor Emeritus (and former Governor of the Bank of Canada) David Dodge just before the speech.
VIDEO LINKS TO THE CANADIAN CLUB SPEECH:
Respected American health journalist Trudy Lieberman reports today on Dr. Gary Bloch’s work to reduce poverty as a way to improve health in his patients. She hopes that America can follow his lead. Click here to read her story.
Recently, our colleagues at the American Medical Association published what they see as the top eight challenges and solutions for improving the usability of electronic medical records (EMRs). Read all about it here:
Globe and Mail journalist Carly Weeks is as frustrated as I am. Here are the facts: No one thinks that more Canadians should smoke marijuana. So how do we proceed with the discussion? Let’s get rid of the politics and insert some evidence and science. Read Carly’s insightful piece here: http://www.theglobeandmail.com/life/health-and-fitness/health/stop-playing-politics-with-teens-brains-and-legalize-pot/article21502986/
The Saskatoon Star Phoenix interviewed me while I was in town to participate in a couple of events. Here is their story.
In Saskatoon, I had the opportunity to come together with several health policy leaders and innovators at the second annual Health Innovation and Public Policy Conference.
The great thing about this conference is that it is student-inspired and run. They did a fantastic job! By my count, over 300 people came to hear the five of us (see promotional poster, above) talk about everything from seniors care to First Nations health to robots. I spoke with several students afterwards; they were all bursting at the seams with great ideas and enthusiasm. The future of our profession is in very capable hands!
Dr. Gary Bloch is one of those guys who “walks the talk”. Poised, smart-as-a-whip, and eloquent, he speaks of “prescribing money” as a way for doctors to help patients who are socioeconomically disadvantaged. Now, he doesn’t actually suggest that we write cheques for patients….but what he means is that we need to make it our business to point them to the available social services and other resources that there are out there – and to help them access all the help that is available. Why should doctors do this? Simple – poverty makes people sick. Gary talks about thinking of poverty as a disease that needs to be treated. Helping people to cope with poverty, or even better, to rise out of poverty, should be the everyday business of doctors just as much as lowering cholesterol or treating infections is.
Check out, and be wowed by, Gary’s TED talk here:
Dr. Ryan Meili is a brilliant young Saskatoon family physician (and a former candidate for the provincial NDP leadership) who argues in his book, A Healthy Society, that the achievement of a healthy Canada should be the goal of provincial/territorial and federal governments and that, furthermore, it is the yardstick against which they should be evaluated and judged. He argues that economic performance is essential to achieving social justice but that it is only a tool – not an outcome in and of itself. We can all celebrate robust economic growth. But are we using our wealth to create a better society? The GDP can’t be the sole measure of success. Rather, economic growth is a tool used to achieve the ultimate success – a healthy and productive population. Ryan also goes into territory I have not seen explored before – the argument that increasing income inequities – the gap between rich and poor – is actually bad for even the rich. Do rich people want to live in gated communities, worried about crime and political instability, or do they want to enjoy being part of a community where they are rewarded and celebrated for their hard work but can also feel safe, secure, and part of a larger community? I encourage you all to read his thoughtful and measured tome. I guarantee that you’ll never think about politics the same way again.
Here is Ryan’s TEDx talk:
I left Saskatoon feeling both humbled and inspired. I have renewed energy in my role as CMA president because people like Ryan and Gary are out there working for our patients and for our country.
As my predecessor, Dr. Louis Francescutti, has said, “It has never been a better time to be a physician”. Ryan and Gary represent physician leadership at its very best.