Town Hall Concensus: Health system failing elderly and chronically ill

Originally published in The Globe and Mail on August 10th, 2011. To go to the Globe and Mail website please click here

Cancelled surgeries. Patients who need hospital care but who can’t get it. Families forced to sell their homes to pay for an autistic child’s treatment.

In person and online, thousands of Canadians who participated in a nationwide consultation over the past year say the country’s health system is faltering badly and that more needs to be done to deliver care when and where it’s needed.

The nation’s “once proud” health system is fundamentally fractured and failing — especially for vulnerable groups such as children, the elderly, aboriginal peoples and those with mental illness — says a new report from the Canadian Medical Association.

The “Voices Into Action” document summarizes what the country’s largest doctors’ group heard from nearly 1,500 Canadians who attended six standing-room-only public town halls, in Halifax, Toronto, Edmonton, Vancouver, La Prairie, Que. (the south shore of Montreal) and Ottawa, as well as more than 4,000 online comments.

“Without a doubt concerns about our health care system run deep,” says the report. “We heard that there is a ‘moral imperative’ to fix the system, but that our biggest adversary is apathy.”

Canadians spoke about long wait times, the high cost of prescription drugs, patients languishing on hospital wards who need care in long-term facilities, doctors offering next-day surgery in a private clinic for $2,000 rather than have the patient wait a year or two to do so in hospital, and the need to spend less money on administration and more on front-line workers and services.

“Normally people just automatically say: ‘Just give us more money.’ That didn’t happen,” said CMA president Dr. Jeff Turnbull, chief of staff at The Ottawa Hospital.

“They said we need value for money, we need management, we need better delivery systems so that we’re accountable for health care.”

Turnbull said he was struck by the strong and clear support for a publicly funded health system. “They recognized it was failing them, but universally everyone we spoke to said this health care system is important to us, we believe in it and we think that it can be fixed,” said Turnbull.

But he also heard tragic, “real-life” stories of a system consistently failing patients.

“We heard of people who waited inordinately long — and their health suffered as a result of that — to get meaningful, thoughtful services,” Turnbull said.

“Long waits in emergency departments, cancelled surgeries — we heard that right across the country. We heard of not being able to access a primary-care physician, right across the country.

“We heard about people surprised that they had to pay for long-term care or home-based care. We heard passionate responses from patients saying, ‘My son has autism. This is a medical disorder but I can’t pay for that.’ People saying that, ‘I can’t afford medications that would cure my illness.’

“I just can’t conceive of that in Canada. It’s not the health-care system I want to work in.”

One woman in Halifax who was caring for someone dying from pancreatic cancer talked about the “insane amounts of time” she spent waiting to meet with health care providers. Another woman in Edmonton told how her husband, who died 18 months ago, “did not die a death with dignity.” She couldn’t take him home when he begged her to because she couldn’t look after him at home, alone.

“With the population aging there is an urgent need to build a system of home-based care to provide families with the support they need to allow patients to get the best care they can at home,” the report says.

Many said the Canada Health Act, which covers only doctor and hospital care, should be broadened in scope to include home care as well as a national prescription drug plan.

Others spoke about the need to address access to affordable housing, food and other conditions that determine health. At the town hall in Toronto, one audience member told of a woman admitted to Toronto General Hospital with an abdominal blockage so severe she needed radical surgery. The woman was on welfare; all she could afford to eat was white rice.

“It cost more to perform that operation than it would have cost to feed (her) good nutritious vegetables for 20 years.”

The report says the system is good at providing acute, or short-term care immediately after an illness or injury — what one participant called “Humpty Dumpty medicine.” Where it fails, participants said, is in providing care to the elderly and others with chronic, long-term illnesses.

Dr. Chris Simpson is chair of the Wait Time Alliance, an association of medical societies lobbying for more efficient health services. He said the report builds on a growing consensus that patients need to be put first.

“It’s not just about a wait time for a single test or procedure — it’s about a whole patient journey,” said Simpson, professor and head of the division of cardiology at Queen’s University in Kingston, Ont.

Take a patient having bypass surgery. “We measure and report how long it takes to wait to get bypass surgery. What we don’t take into consideration is how long did it take for them to come to attention in the first place? Did they have a family doctor? Did they have to come to the emergency room? Did they wait in the emergency room? How many tests did they have to have and how long did they wait for those?

“People want to know, ‘What’s going on, how much does it cost and why can’t we do any better?'”

The doctors’ group is hoping to get the attention of the federal and provincial governments as it heads into its 144th annual meeting in St. John’s Aug. 21-24. This year’s meeting will be dominated by discussions on the federal-provincial health-accord, due to expire in 2014.

“Everybody has to come to the table,” Turnbull said. People want to see “action, they want to see change in the way we deliver services and where we deliver services and how we do that. And they want some leadership.”

Canada’s premiers and doctors are looking to secure a new long-term health transfer deal from the federal government. In June, the Harper government pledged continual six-per-cent increases in federal health care transfers to the provinces.

© The Globe and Mail