HESA Committee Report

The previous section assessed the extent or lack of progress achieved under each component of the 10-Year Plan on the basis of the testimony heard and briefs received during the hearings. In this section, the Committee makes recommendations to move forward on the comprehensive health care agenda set out in the plan, with a particular focus on the role of the federal government.

A. Reporting

Public reporting is a key component of the 10-Year Plan. It was agreed that Canadians would be kept regularly informed on the pace of health care reform and that they would be able to see how their governments were doing on meeting the 10-Year Plan commitments. Although some of the required reports have been prepared, and despite the work already done by the Health Council and CIHI, the reality is that jurisdictions have not reported to their citizens in a systematic and timely manner as initially agreed.

Unfortunately, this is particularly true for the federal government. When they appeared before the Committee, government officials did not provide details on the progress achieved by the federal government under each of the ten components of the 10-Year Plan. This information was requested in writing following a motion to that effect adopted on April 17, 2008 and again on June 4, 2008. Health Canada's response was received after the end of the Committee's deliberations and is provided in Appendix B of this report. The Committee is concerned that such information has not been provided in a timely manner. This would have greatly facilitated the statutory review of the 10-Year Plan. It is of paramount importance that all jurisdictions, including the federal government, provide the reports required under the 10-Year Plan.

On the basis of the testimony received, the Committee concludes that both the Health Council and CIHI comply with their requirement of reporting to the public on an annual basis. However, there appears to be no systematic and uniform reporting by all jurisdictions on the plan's implementation. This makes it difficult for the Health Council and CIHI to show Canadians how governments are doing on meeting their commitments under the 10-Year Plan. In its view, the provision of relevant information by all jurisdictions is needed to assess and report on progress in health care renewal and to make progress transparent to citizens. And again, this applies to all jurisdictions, the federal government included. Therefore, the Committee recommends:

Recommendation 1

That the federal government comply with the requirement of reporting on its progress on all components of the 10-Year Plan; that it fulfill this requirement by the end of the 2008-09 fiscal year; and that it encourage all jurisdictions to provide the required public reports within the specific 10-Year Plan deadlines.

B. Data Collection

Monitoring and reporting on the implementation of the 10-Year Plan is further complicated by a lack of data and, when data do exist, by a lack of uniformity. As mentioned earlier, wait time data are measured in diverse ways, statistics on health human resources are insufficient, multidisciplinary teams is not a term well

The Committee concurs with witnesses that the lack of consistent, comparable data creates significant challenges in evaluating reform and in reporting on progress. Despite the commendable work of existing organizations devoted to health information, the Committee and all Canadians need more data and comparable indicators, as well as the improved collaboration and sharing of information among all jurisdictions to assess progress on the 10-Year Plan. Therefore, the Committee recommends:

Recommendation 2

That the federal government, in collaboration with the provinces and territories and in partnership with the Health Council of Canada and the Canadian Institute for Health Information, agree on a set of comparable data and indicators to ensure proper assessment of progress under the 10-Year Plan; that the federal government ensure that this set of indicators is relevant to its client groups; and that this work be completed by the end of 2008-09 fiscal year.

C. Federal Funding

The Committee acknowledges that no legislative or other provision was put in place whereby the provinces would be penalized if they did not comply with the 10-Year Plan, leaving the provinces to be voluntarily accountable to their citizens, but not to the federal government. This is why improved public reporting by all jurisdictions on progress in health care renewal must be given priority, as the Committee's first recommendation suggests. Canadian taxpayers deserve greater transparency for the billions of tax dollars invested under the 10-Year Plan.

The Health Council's reports have noted repeatedly that, while the federal government provides its allocation estimates for each jurisdiction on the Department of Finance website, it does not provide separate reports for the populations under its own direct responsibility. Therefore, the Committee recommends:

Recommendation 3

That the federal government specifically report on funding provisions relevant to the populations for which it has direct responsibility.

D. Pan-Canadian Collaboration

When they agreed on the 10-Year Plan, First Ministers envisioned that governments would collaborate to solve common problems for the benefits of all Canadians, wherever they live. Numerous witnesses told the Committee about the need to revive the idea of a common pan-Canadian vision to strengthen health care and to put mechanisms in place to make this vision a reality.

Some mechanisms already exist, like the Pan-Canadian Health Human Resource Planning Framework, but it is not receiving the attention and support from all stakeholders that it must have to succeed. Canada Health Infoway is another existing common pan-Canadian framework, which is dedicated to the development of electronic health records (EHRs) and telehealth, two other components of the 10-Year Plan. In these areas, progress could be accelerated through enhanced intergovernmental collaboration. And with respect to pharmaceutical management, the National Pharmaceuticals Strategy (NPS) has been established as a pan-Canadian framework to address pharmaceutical issues in a collaborative manner, but there has been little, if any, activity since 2006.

Other processes established to facilitate pan-Canadian collaboration have simply been disbanded, such as the Best Practices Network (primary health care reform) and the F/P/T Advisory Committee on Governance and Accountability (information sharing on funding provisions).

The Committee is aware that the reality of health care in Canada is that we do not have a single system, we have at least 14, including the care that the federal government delivers or directly funds. This reality presents challenges for coordinating reform on a large scale. But it agrees with witnesses that a coordination that transcends both geographic and political boundaries is needed to address the critical issues related to many components of the 10-Year Plan. Therefore, the Committee recommends:

Recommendation 4

That the federal, provincial and territorial governments publicly recommit to the nationwide collaboration envisioned in the 10-Year Plan; and that the federal government ensure collaboration among its client groups across the country.

E. Aboriginal Health

Members on the Committee are concerned about the lack of information on progress in implementing the Blueprint on Aboriginal Health. Moreover, little is known about the promising Aboriginal Health Reporting Framework, which could significantly improve Canada's ability to understand and monitor the health status of Aboriginal peoples. Therefore, the Committee recommends:

Recommendation 5

That the federal government table a report to Parliament on the progress in the implementation of the Blueprint on Aboriginal Health, the development of the Aboriginal Health Reporting Framework, and specifically on the fulfillment of its work for First Nations and Inuit populations before the end of 2008-09.