HESA Committee Report

APPENDIX B

Forwarded by e-mail to the Clerk of the Committee on Tuesday, June 10, 2008 at 10:15 a.m.

Carmen DePape

Clerk, Standing Committee on Health

Sixth Floor, 131 Queen Street

House of Commons

Ottawa ON K1A 0A6

Dear Ms. DePape:

I am writing in response to the June 5, 2008 motion adopted by the Standing Committee on Health,

That the Ministry of Health, together with the Public Health Agency of Canada, table by June 10, 2008 their analysis of the progress to date in each of the sections of the First Ministers’ Meeting on the 2004 Health Accord, as previously requested by the Committee on April 17, 2008; and that the Provinces not be bound by the current motion.

In our response to a similar motion from the Committee, dated April 17, 2008, we supplied the most comprehensive information available from the Health Council of Canada on progress on each of the aspects of the 2004 Accord. 

As the current motion asks specifically for analysis by Health Canada and the Public Health Agency of Canada, we are pleased to provide the Committee with an analysis of implementation of each of the 10 aspects of the Accord, which was prepared for our internal use prior to our appearance before the Committee on this matter. 

I wish the Committee every success in its deliberations.

Yours sincerely,

Karen L. Dodds, Ph.D

Assistant Deputy Minister

Enclosures (10)

ANALYSIS OF IMPLEMENTATION

REDUCING WAIT TIMES AND IMPROVING ACCESS

F/P/T governments are making significant progress on their commitments in the 2004 Health Accord to achieve meaningful reductions in wait times and to collect and provide information to Canadians on their progress.

Reducing Wait Times

2004 Health Accord Funding

The Government of Canada has met its commitment under the 2004 Accord by providing $5.5 billion to provinces and territories through the Wait Times Reduction Fund, as part of $41 billion in additional federal transfers over 10 years to strengthen health care.  The Wait Time Reduction Fund has allowed P/Ts to augment their existing investments to support diverse initiatives to reduce wait times.  Investing in this way recognizes the P/Ts’ responsibility for the delivery of health care and supports their efforts to ensure timely access to quality care.

National Wait Times Initiative

In addition, the Government of Canada has invested in the development and dissemination of knowledge to inform wait times management and reduction strategies through the National Wait Times Initiative (NWTI). Budget 2005 originally allocated $15 million over four years for the NWTI, in order to support wait times initiatives that would build on and complement P/T initiatives.  However, as the 2005 Supplementary Estimates were not passed, the NWTI did not receive the first year’s $2 million allocation. As a result, the NWTI was budgeted for $13 million over three years (2006/07 to 2008/09).

Examples of outcomes to date include: new partnerships between surgeons, other health care professionals and provincial governments to improve management of wait times for orthopaedic surgery; the adoption of lessons learned through a model to promote appropriateness of diagnostic imaging; and the establishment of the first national database on paediatric surgical wait times.

Benchmarks

On December 12, 2005, governments announced ten common wait times benchmarks in the four priority areas of cardiac and cancer care, joint replacements and sight restoration.  These benchmarks, based on research and clinical evidence, cover hip and knee replacements, hip fracture fixation, cataract surgery, breast and cervical cancer screening, and radiation therapy for cancer and cardiac bypass surgery.

While governments have not yet established an evidence-based benchmark for diagnostic imaging, this is in large part because appropriate use of such technologies and associated evidence on acceptable wait times are under debate.  Governments have committed to develop more benchmarks as new evidence is produced and are collaborating with the Canadian Institutes of Health Research and clinicians on work that could support the establishment of additional benchmarks.

Targets

In the 2004 Accord, P/Ts committed to establish multi-year targets to achieve priority benchmarks by December 31, 2007.  As of March 2008, five provinces (Alberta, Ontario, Quebec, Prince Edward Island and Saskatchewan) had declared targets.  These sets of targets vary; only Alberta has publicly declared targets in relation to all the benchmarks.  Saskatchewan's publicly available surgical targets were established prior to the 2004 Accord.  Quebec’s targets are tied to its guarantee of access as set out in Bill 33.  In addition, several provinces (Manitoba, Nova Scotia and New Brunswick) have publicly stated that they remain committed to establishing targets.  It is important to note that all P/Ts have stated that they consider the benchmarks to be goals they will strive to meet.

Wait Time Reductions

Since the 2004 Accord was signed, governments have implemented a variety of measures to reduce wait times, particularly in the five priority areas specifically identified (cancer, heart, diagnostic imaging, joint replacements and sight restoration).  P/T strategies to improve the way wait times are monitored, measured and managed include:

• building capacity;
• using technology to monitor and measure wait times;
• managing access to help patients navigate the health system;
• clarifying how hospitals, health service organizations and health providers are responsible for making health care more accessible and accountable to Canadians; and,
• evaluating patients’ access to health care and health outcomes to help governments determine where resources should be directed for the most effective results.

While activities and progress vary across clinical areas and jurisdictions, all P/Ts are working to achieve further reductions in wait times within and beyond the five priority areas. Concrete improvements have been achieved as a result.  For example:

• In Alberta, 90% of patients were receiving cardiac bypass surgery within 11 weeks in January 2008, down from 17.5 weeks in January 2007.¹
• In Manitoba, the median wait time for cancer radiation therapy was one week in January 2008.² In 1999, cancer patients would have waited six weeks or longer for this treatment.³
• In Ontario, between November 2004 and April 2007, wait times for hip replacements dropped by 27% (or 94 days), while waits for knee replacements fell 30% (or 133 days) and wait times for cataract surgery decreased 41% (or 128 days).⁴
• The Quebec government has reported sharp reductions in long waits for such procedures as cataract surgery (down 64%) and hip and knee surgery (down 45% and 60% respectively) between 2003 and 2007.⁵
• In Nova Scotia, the rate of mammograms for women 50-69 years old has nearly doubled since the start of the decade, and the average wait time for mammography screening in hospitals dropped from 44 weeks in 2005 to 11 weeks in 2006.⁶

Recognizing these efforts, in 2007, the Health Council of Canada reported that a significant amount of activity was underway in every jurisdiction, and the Wait Time Alliance noted that progress has been made in reducing wait times.  The Canadian Institute for Health Information (CIHI) recently reported that the number of surgeries in priority areas for wait times reductions increased by 7% in 2005-06 from the previous year, while surgeries outside the priority areas increased by 2%.

Patient Wait Times Guarantees

One of the federal government’s current priorities is to support the development and implementation of Patient Wait Times Guarantees (PWTGs) across the country.  In Spring 2007, all P/Ts agreed to establish a PWTG in a priority area by 2010.  This commitment to establish PWTGs marks a new milestone in wait times reduction efforts.  Guarantees will move the health care system further toward more responsive patient‑centred care, providing patients with greater certainty of timely access.

PWTGs include two key elements:

• a defined time frame to establish when medically necessary health care services should be delivered; and,
• access to alternative care options that are automatically offered to patients if the system fails to deliver treatment within the defined time frame.

As committed in Budget 2007, more than $1 billion in new federal funding is being provided to P/Ts and Canada Health Infoway to support the development and establishment of PWTGs.  This includes:

• $612 million for a Patient Wait Times Guarantee Trust, which will assist P/Ts in their diverse initiatives to improve certainty of timely access to insured health care services. Under the guiding principles of the PWTG Trust, P/Ts may choose to:
• build surge capacity to meet a PWTG;
• reconfigure service delivery to facilitate improved use of system resources;
• purchase new or replacement medical equipment necessary to realize a PWTG;
• train and hire health care professionals, including patient navigators or care coordinators;
• support patient travel assistance for timely care within or outside the home jurisdiction;
• develop and implement wait times management practices and efficiency measures to improve patient flow; and,
• develop and implement public, patient and provider education related to the introduction and implementation of a PWTG.
• $400 million in funding to Canada Health Infoway, to support the implementation of guarantees  through the development of health information systems and electronic health records.
• A $30 million PWTG Pilot Project Fund, which will assist P/Ts in testing innovative approaches PWTGs, including options for alternate care (recourse) when time frames are exceeded. To date, three pilot projects have been announced under this initiative:
• Nova Scotia will receive up to $8 million for two pilot projects which will test PWTGs in the areas of diagnostic imaging and orthopaedic surgical services.
• Manitoba is receiving up to $5.8 million for a pilot project which will streamline referrals from general practitioners to specialists, in areas including cancer services orthopaedics, ophthalmology and mental health.
• Contribution agreements for seven other PWTG pilot projects have been finalized, for innovative projects across a range of clinical areas.

The Government of Canada is also funding four federal pilot projects to test guarantees:

• In November 2006, the Government of Canada announced the development of two pilot projects in the areas of diabetes and prenatal care in selected First Nations (FN) communities. Funding for these two pilot projects come from existing First Nations and Inuit Health Branch (FNIHB) programs.
• On January 5, 2007, the Government of Canada announced that Saint Elizabeth Health Care would receive up to $3.7 million over 18 months for a pilot project to establish a wait times guarantee in the area of diabetic foot ulcer care for First Nations people living on reserve in Manitoba. This pilot project is funded through the NWTI.
• On January 11, 2007, the Government of Canada announced a pilot project in the area of paediatric wait times.  The Hospital for Sick Children (SickKids), on behalf of Canada's 16 Paediatric Academic Health Science Centres (PAHSCs), is receiving up to $2,901,678 over 15 months for a pilot project that will improve access and certainty of timely care for paediatric surgery. This pilot project is funded through the NWTI.

The work on guarantees builds on governments’ accomplishments to date on wait times and contributes to overall improvements in the health care system.

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Public Accountability

Comparable Access Indicators

In March 2006, P/T governments endorsed comparable indicators of access to healthcare professionals, diagnostic imaging, joint replacement, sight restoration and cancer and cardiac care.  P/Ts have worked with CIHI on the further development of data and definitions for reporting on comparable access indicators. CIHI noted in February 2008 that while “publicly available wait time information has increased significantly over time,” comparable provincial data are still evolving. CIHI points to initiatives in many jurisdictions to improve data quality, while noting that the variations across provinces in wait time measures mean that reported wait times are not yet comparable from one jurisdiction to the next.

Reporting

All jurisdictions have taken steps to inform their residents about wait times through such means as public reports and news releases and websites.  In fact most P/Ts are now reporting regularly on publicly accessible websites dedicated to wait times information.  While the quality of reporting varies by jurisdiction, the Health Council in 2007 noted “a significant step forward” in wait times reporting.  In February 2008 CIHI reported that publicly available wait times information has “increased significantly,” with provinces reporting on more priority areas, providing more recent data and enhanced detail.  CIHI also noted that many provinces are working to improve the quality of their wait times information and that it has become possible to look at progress over time in selected priority areas in some provinces.

CIHI has met its commitment to report on progress on wait times across jurisdictions.  For example, it has released three annual editions of Wait Times Tables ‑ A Comparison by Province, the most recent in February 2008, as well as Waiting for Health Care in Canada: What We Know and What Don't Know (March 2006).  The Heath Council of Canada also releases regular updates on wait times progress as well as full reports on the issue, such as Wading Through Wait Times: What Do Meaningful Reductions and Guarantees Mean? (June 2007).  In addition, Statistics Canada’s Health Services Access Survey provides a comparable measure of Canadians’ experiences and perceptions at the national and provincial level.

Health Council of Canada Comments

The Health Council of Canada in June 2007 released a report, Wading Through Wait Times: What Do Meaningful Reductions and Guarantees Mean?, which provided an update on progress in reducing wait times in the five priority areas set out in the 2004 Accord. The report noted that there is a significant amount of activity underway to improve wait times in every jurisdiction, and suggests that P/T public reporting on wait times has made a "significant step forward". Citing “a lack of comprehensive and comparable data," which are important to track progress, the report was not conclusive on whether meaningful reductions were achieved by the March 2007 deadline.