Question Period Note: Palliative care

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• Federal action to improve access to palliative care in Canada
• Canadians with serious illness or approaching the end of life deserve to receive care in the setting of their choice with comfort and dignity.
• Our Government has collaborated with provinces, territories, health care providers and stakeholders, to develop a Framework and implement the Action Plan on Palliative Care, including investments of $24 million from 2019 to 2021, and $29.8 million from 2021-2027.
• This funding complements federal support exceeding $6 billion over 10 years to provinces and territories for home and community care, including palliative care.

IF PRESSED ABOUT THE ACTION PLAN ON PALLIATIVE CARE …
• The Action Plan on Palliative Care lays out Health Canada’s multi-year plan to tackle issues identified in the Framework on Palliative Care in Canada. Actions include raising awareness of the importance of palliative care; providing public education on grief; improving palliative care skills and supports for health care providers, families, caregivers, and communities; enhancing data collection and research; and improving access to culturally sensitive palliative and end-of-life care.
• Our government will continue to work with provinces, territories and health partners to improve access to home, community and palliative care.

IF PRESSED ON WHAT THE FEDERAL GOVERNMENT HAS DONE TO SUPPORT PALLIATIVE CARE DELIVERY DURING THE PANDEMIC …
• While continuing to work with health partners to implement the Action Plan on Palliative Care, Health Canada has invested $10.3 million in funding for Action Plan initiatives that respond to urgent needs created by the pandemic. These projects leverage virtual tools and caring communities to improve palliative care delivery across all settings, including at home and in the community.

NEED FOR IMPROVEMENT IN PALLIATIVE CARE SERVICES
A 2018 report by the Canadian Institute for Health Information (CIHI) noted that:
o While 75% of Canadians would prefer to die at home, only about 15% have access to palliative home care services.
o Recipients of home palliative care services are 2.5 times more likely to die at home, and are less likely to receive care in an emergency department, or intensive care unit.

COMPLEMENTARY MECHANISMS
The Framework on Palliative Care sets out an approach under which all governments, communities, and Canadians play a role in improving palliative and end-of-life care. The Framework was built through participation and direction-setting with key organizations, provinces and territories (P/Ts), other federal government departments and individuals, including people living with a life-limiting illness, caregivers, health care providers, and researchers. The penultimate version of the Framework was shared with P/Ts, stakeholders, and other participants in the development process, and their feedback incorporated. Although formal endorsement was not sought, other jurisdictions and key stakeholders were comfortable in sharing their approaches to palliative care to be included in the Framework and being named as contributors in the final document. A list of the main groups and individuals that contributed to the development of the Framework is contained in the document.

The Action Plan on Palliative Care focuses on the federal role in implementing the Framework. The Common Statement of Principles on Shared Health Priorities, as described below, outlines the way that the federal government and provincial and territorial government work together to improve palliative care, and complements the Framework and Action Plan.

Shared Health Priorities and Bilateral Agreements:
In August 2017, FPT Ministers of Health (except Quebec) agreed to the Common Statement of Principles on Shared Health Priorities (CSoP) which set out a shared agenda for improving access to home and community care (including palliative care) and mental health and addiction services supported by federal investments. Based on the asymmetrical agreements of 2004, the Government of Canada and the Government of Québec agreed to an asymmetrical arrangement distinct from the CSoP.

Following the endorsement of the CSoP, the Government of Canada negotiated and finalized bilateral agreements with each jurisdiction, which are posted publicly online. These agreements detail how each province or territory will use federal investments to increase access to services in the two priority areas. Each jurisdiction developed its own action plan, annexed to the bilateral agreement, which identifies the new or expanded programs in home and community care and mental health and addiction services to be supported by the federal investments.

Six billion dollars in funding over 10 years was committed for home and community care (including palliative care), and was allocated to each province and territory on a per capita basis. While the first phase of bilateral agreements recently expired (March 31, 2022), federal, provincial and territorial governments will work together to renew or extend agreements in fiscal year 2022-23 so that provinces and territories can use the remainder of the funding over the next five years to support home and community care (including palliative care).

RESPONDING TO NEEDS CREATED OR EXPOSED BY COVID-19
In addition to the initiatives identified in the Action Plan on Palliative Care, Health Canada and its partners are also working on initiatives that will contribute to the delivery of palliative care in the new environment created by the pandemic. They have responded to current priorities including symptom control, information sharing, virtual care, advance care planning, and isolation. Recent activities include:
o Funding projects in support of palliative care delivery:
• In addition to the $2.5 million investment over the past five years, the Canadian Hospice Palliative Care Association received an additional $612,829 to develop advance care planning tools and resources for long-term care residents and family, as well as tools and resources for health care providers and workers in long-term care facilities.
• The Canadian Virtual Hospice has received $586,534, in addition to the $2.5 million already committed to develop resources for underserved populations (francophones, LGBTQ2S, children, MAID), to develop a series of online learning modules for caregivers and palliative care patients; host discussion forums for healthcare professionals; raise public awareness; and develop modules to provide grief support to care providers.
• William Osler’s RELIEF Project received $1.4 million to facilitate palliative care delivery to vulnerable populations through the use of technology to enable Remote Self-Reporting of Symptoms by Patients with Palliative Care Needs.
• University of British Columbia received $2.25 million for its Volunteer Navigation in Palliative Care: Adapting and Expanding the Nav-CARE program - in which trained volunteers provide navigation services to persons living at home with life-limiting illness using a palliative and compassionate community approach.
• Pallium Canada received $450,000 to provide webinars, training and other resources to clinicians responding to the pandemic. In addition, Pallium is receiving new funding of $5 million for Project ECHO. This project is building local palliative care capacity among health care providers through a tele-mentoring approach, including the regular and ongoing provision of information, resources, and ongoing supports, such as how to effectively deliver virtual palliative care services.
• Bruyère Research Institute received $2.5 million to expand the work of the Pan-Canadian Palliative Care Research Collaborative in conducting 14 research studies to improve patient and caregiver outcomes, palliative care health system performance, and people’s experience of palliative care, and by building knowledge translation capacity to share the results of this research;
• McMaster University received $1.5 million to expand its Strengthening a Palliative Approach in Long-Term Care Program, which aims to improve the access and use of knowledge, tools, and resources to improve the quality of living and dying for residents and their family members within all long-term care homes in Canada, by curating, adapting, and disseminating resources for direct care, program development and staff training, and consolidating these resources in an accessible national repository.

INDIGENOUS PEOPLES
Budget 2017 allocated Indigenous Services Canada (ISC) $184.6 million over five years to improve home and palliative care for First Nations and Inuit communities. In addition, funding was identified in Budget 2021 to implement the Action Plan on Palliative Care. Approximately $4.1 million of this funding is earmarked for Indigenous palliative care, with $1.1M for the Indigenous engagement process, and the rest for targeted investments which will be allocated according to the priorities set through the engagement process and a subsequent Indigenous palliative care framework. During the development of the Framework and Action Plan, National Indigenous Organizations (NIOs) indicated their interest in discussing Indigenous-led engagement processes toward the development of a separate distinctions-based framework on palliative care. This engagement is planned in collaboration with ISC. Engagement with Indigenous groups will be a complex and multi-faceted process. ISC has begun the engagement process with First Nations and Inuit peoples on long-term care, including palliative care. Plans for other streams of engagement by Health Canada (e.g., Indigenous health providers, Métis peoples, urban Indigenous populations) are also underway.

Responding to advice from Elders, Knowledge Carriers, community health professionals and researchers, the Canadian Partnership Against Cancer (CPAC) is launching a multi-year pan-Canadian initiative that will make tools, resources and education available to improve home and community-based palliative care for First Nations, Inuit and Metis communities. Leveraging our ongoing partnership with CPAC, Health Canada is providing additional funding ($1 million over 2 years) to allow the initiative to reach more Indigenous communities wishing to improve their end-of-life care.

PALLIATIVE AND END-OF-LIFE CARE FOR CHILDREN AND YOUTH
Children and youth who have a life-limiting illness or condition, or who have a family member or friend with one, require appropriate supports and acknowledgement of their experience, including when they are grieving a loss. Depending on their needs, young people may be cared for by their family physician, pediatrician, allied health care providers, and/or pediatric palliative care specialists. Young people and their families and caregivers may also benefit from community and online information and other resources which address their experiences and aim to alleviate their suffering. The federal government has supported the development of content for websites such as:
• CaringTogether.Life to educate, support, and empower parents caring for a seriously ill child and those who are experiencing pregnancy or infant loss;
• LivingOutLoud.Life for teens and young adults living with advanced illness; and
• KidsGrief.ca, for parents supporting their children when someone in their life is dying or has died.

Medical Assistance in Dying (MAID): In Canada, a person must be at least 18 years to request MAID; therefore, mature minors are currently not eligible for MAID. “Mature minor” is a legal term that refers to young people below the age of majority who are deemed competent to make their own medical decisions. The issue of MAID and mature minors is one of the topics to be addressed by the Special Joint Committee on MAID (AMAD), in addition to the state of palliative care.

OTHER FEDERAL INVESTMENTS IN PALLIATIVE CARE
In terms of research funding, the Canadian Institutes of Health Research (CIHR), along with the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Social Sciences and Humanities Research Council (SSHRC), has supported the Canadian Frailty Network through the Networks of Centres of Excellence Program, with an investment of $47.8 million between 2012 and 2023. This network aims to improve the care of seriously ill, frail elderly patients/families through the development, evaluation, and implementation of health care technologies.

In 2020-21 alone, CIHR, through its Institute of Aging, invested $2 million in palliative care research. More broadly, between 2016-17 and 2020-21, CIHR invested more than $464 million in research on aging. This includes research to promote healthy aging and to address causes, prevention, treatment and palliation for a wide range of conditions associated with aging.

• The COVID-19 pandemic has strained resources and exposed gaps and systemic vulnerabilities in palliative care delivery across all settings.
• Federal investments of $24 million from 2019 to 2021 and $29.8 million from 2021 to 2027 will advance the Government’s Action Plan on Palliative Care and lay a better foundation for coordinated action on supportive care needs.
• This funding complements federal investments exceeding $6 billion over 10 years to provinces and territories for home and community care, including palliative care, under the Common Statement of Principles on Shared Health Priorities