HESA Committee Report

Liberal Report for Review of 2004 Accord
(Supplementary Opinion)

In September 2004 the First Ministers met with Aboriginal leaders and then went on to sign a historic Accord on the future of Health and Health Care for Canada. There was an overwhelming sense of consensus and hope.

Since their election in January 2006, The Conservative Government has demonstrated that honoring the commitments for the Government of Canada in the Accord is not a priority for them. They have provided no leadership in the areas of shared responsibility and virtually no action on the areas in federal jurisdiction. 

Rereading the Accord reminds us of a better time:

“In recent years, through an ongoing dialogue between governments, patients, health care providers and Canadians more generally, a deep and broad consensus has emerged on a shared agenda for renewal of health care in Canada. This agenda is focused on ensuring that Canadians have access to the care they need, when they need it.”

The ‘ongoing dialogue’ has virtually ceased. Meetings of federal and provincial Health Ministers have been repeatedly cancelled. Working groups on commitments such as Health Human Resources and a National Pharmaceutical Strategy have virtually no federal presence. This Conservative government has taken a rigid stance on health care being a provincial responsibility and has therefore refused to participate. The responsibility for the health of Canadians is clearly a shared responsibility across all government departments, across all jurisdictions and across all sectors. There is no partner in Ottawa for Health and Health Care.

At the time of the Accord, it was clear that Canadians’ confidence in the system was eroding because of concerns about long Wait Times -

“First Ministers agree that access to timely care across Canada is our biggest concern and a national priority.” First Ministers came together “and agreed on an action plan based on the following principles:

• universality, accessibility, portability, comprehensiveness, and public administration;
• access to medically necessary health services based on need, not ability to pay;
• reforms focused on the needs of patients to ensure that all Canadians have access to the health care services they need, when they need them;
• collaboration between all governments, working together in common purpose to meet the evolving health care needs of Canadians;
• advancement through the sharing of best practices;
• continued accountability and provision of information to make progress transparent to citizens;
• and jurisdictional flexibility.

Unfortunately, the failure to properly enforce the Canada Health Act means that there are places in Canada where citizens can pay to get to the front of the line. There has been a total breakdown in the collaboration agreed to in the principles as outlined above. Sharing of best practices is still being down on an ad hoc base and the areas of federal responsibility like Aboriginal Health, Military, Veterans, etc. are not learning from the provinces as they would be if there was the proper structure and communication.

The biggest disappointment is the commitment to accountability and provision of information to make progress transparent to citizens is virtually non-existent. It is patently obvious citizens must be able to compare the progress in their jurisdiction to others. Data and information must be comparable and easy for citizens to understand. The Conservative Government has interpreted the provision of ‘jurisdictional flexibility’ to one of total abdication of the federal role without any accountability for outcomes. The $42 billion was to ‘Buy Change’. Without the appropriate reporting mechanisms, Canadians have no idea whether or not their money was well spent.

Reducing Wait Times and Improving Access

First Ministers committed to achieving meaningful reductions in wait times in priority areas such as cancer, cardiac care, diagnostic imaging, joint replacements, and sight restoration by March 31, 2007; recognizing the different starting points, priorities, and strategies across jurisdictions. Canadians expected reporting on all 5 priority areas from all jurisdictions. Instead, each province chose one area to report on.

First Ministers agreed to collect and provide meaningful information to Canadians on progress made in reducing wait times, as follows:

“Each jurisdiction agrees to establish comparable indicators of access to health care professionals, diagnostic and treatment procedures with a report to their citizens to be developed by all jurisdictions by December 31, 2005.”

This was done.

 “Evidence-based benchmarks for medically acceptable wait times starting with cancer, heart, diagnostic imaging procedures, joint replacements, and sight restoration will be established by December 31, 2005 through a process to be developed by Federal, Provincial and Territorial Ministers of Health.”

This was done.

“Multi-year targets to achieve priority benchmarks will be established by each jurisdiction by December 31, 2007.”

Not done

“Provinces and territories will report annually to their citizens on their progress in meeting their multi-year wait time targets.”

Not done.

Strategic Health Human Resource (HHR) Action Plans

There is an acknowledged crisis in the shortages of health care professionals in Canada; including doctors, nurses, pharmacists, and technologists. These shortages are particularly acute in some parts of the country.

First Ministers agreed to continue and accelerate their work on Health Human Resources action plans and/or initiatives to ensure an adequate supply and appropriate mix of health care professionals.

Federal, provincial and territorial governments agreed to “increase the supply of health professionals, based on their assessment of the gaps and to make their action plans public, including targets for the training, recruitment and retention of professionals by December 31, 2005.” Federal, provincial and territorial governments pledged to make these commitments public and regularly report on progress. Unfortunately, Canadians are still in the dark about any such progress.

The federal government committed to:

“accelerate and expand the assessment and integration of internationally trained health care graduates for participating governments”

Canadians are still worried that there has been little progress on this. The federal government committed to help. The federal government has a responsibility to report clearly on the progress in this area.

“targeted efforts in support of Aboriginal communities and Official Languages Minority Communities to increase the supply of health care professionals for these communities”

The federal government has an obligation to clearly report on the progress in increasing their supply of health care professionals in Aboriginal Communities and Official Languages Minority communities. One hundred million dollars in the Accord was dedicated to Aboriginal Health Human Resources. In order to improve the health status of our aboriginal peoples, we urgently need more aboriginal health professionals. The federal government has a moral and constitutional responsibility to let Canadians know the progress on this essential file and invest more dollars if the progress is too slow.

“measures to reduce the financial burden on students in specific health education programs”

The federal government must do more to reduce the financial burden of students in health disciplines. Since the time of the Accord the average debt of medical students has continued to escalate. The average income of the parents of medical students is rising. The federal government must intervene as student debt is an unacceptable deterrent to students from lower income families.

 “participate in health human resource planning with interested jurisdictions.”

The federal government has totally abdicated any active role in HHR planning; it must provide the appropriate incentives and resources to ensure an optimal supply of health human resources for an ageing population. Canada should follow the lead of Norway in establishing ethical guidelines for attracting foreign-trained health professionals.

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Home Care

Even though there was no consensus on a comprehensive Home Care Strategy for Canada within the Canada Health Act, all governments recognized the value of home care as a cost-effective means of delivering services and they are developing home care services to prevent or follow hospitalization.

First Ministers agreed ‘’to provide first dollar coverage by 2006 for certain home care services, based on assessed need.” Each jurisdiction was to “develop a plan for the staged implementation of these services, and report annually to its citizens on progress in implementing home care services.” First Ministers tasked their Health Ministers to explore next steps to fulfill the home care commitment and report to First Ministers by December 31, 2006.

Although certain provinces have made progress in this area there is no real ability for Canadians to know how their province compares with other provinces. There has been no leadership from the federal government in collecting the promised implementation plans or exploring the next steps necessary to fulfill the home care commitment or for jurisdictions to report to Canadians as promised in the Accord.

Primary Care Reform

Although the Communiqué stated that “Timely access to family and community care through primary health care reform is a high priority for all jurisdictions’, between 4 and 5 million Canadians are still without a family doctor. Canadians deserve to know how far we are towards achieving the objective of 50% of Canadians having 24/7 access to multidisciplinary teams by 2011.” The First Ministers agreement to establish a best practices network to share information and find solutions to barriers to progress in primary health care reform such as scope of practice and to regularly report on progress has received no support from the federal government. The popular Primary Care Transition Fund was allowed to sunset. The abdication of a federal role on Health Human Resources has been a huge barrier to progress.

Although First Ministers acknowledged ‘Electronic health records and telehealth are key to health system renewal, particularly for Canadians who live in rural and remote areas.’ the  commitment to accelerate the development and implementation of the electronic health record, including e-prescribing and provide telehealth to improve access for remote and rural communities has been underwhelming. Health infostructure is expensive but is intimately linked with access, quality of care, and patient safety. Therefore it should be a priority for the federal government, as important as building the Canadian Pacific Railway 100 years ago.

Access to Care in the North

The federal government agreed to help address the unique challenges facing the development and delivery of health care services in the North on a priority basis, including the costs of medical transportation. The Paul Martin Government increased funding to the Territories totaling $150 million over 5 years through a Territorial Health Access Fund, targeted at facilitating long-term health reforms, and established a federal/territorial working group to support the management of the fund, and additional direct funding for medical transportation cost. In 2005, the Government of Canada and the Territories announced their vision for the North as promised in the Accord.

National Pharmaceuticals Strategy

First Ministers agreed that no Canadians should suffer undue financial hardship in accessing needed drug therapies. Affordable access to drugs is fundamental to equitable health outcomes for all our citizens.

Even though the Health Ministers did establish a Ministerial Task Force to develop and implement the national pharmaceuticals strategy as promised in the accord, this Task Force is now moribund. The federal government has refused to provide a federal co-chair. Therefore there has been very little progress on the actions outlined in Accord except that done independently by individual jurisdictions. The dream of a National Pharmaceutical Strategy is a distant memory.

‘Develop and assess and cost options for catastrophic pharmaceutical coverage’

Not done.

‘establish a common National Drug Formulary for participating jurisdictions based on safety and cost effectiveness’

Not done

accelerate access to breakthrough drugs for unmet health needs through improvements to the drug approval process

Progress made under the leadership of Minister Dosanjh

strengthen evaluation of real-world drug safety and effectiveness;

A beginning has been made. MED EFFECT - http://www.hc-sc.gc.ca/dhp-mps/medeff/advers-react-neg/index-eng.php

pursue purchasing strategies to obtain best prices for Canadians for drugs and vaccines;

Not done

enhance action to influence the prescribing behaviour of health care professionals so that drugs are used only when needed and the right drug is used for the right problem;

Not done

broaden the practice of e-prescribing through accelerated development and deployment of the Electronic Health Record;

Glacial pace.

accelerate access to non-patented drugs and achieve international parity on prices of non-patented drugs;

Not done

enhance analysis of cost drivers and cost-effectiveness, including best practices in drug plan policies.

Not done

[It is understood that Quebec will maintain its own pharmacare program.]

Prevention, Promotion, and Public Health

Even though the First Minister’s recognized the importance of the healthy development of children and the extensive collaboration by governments through the Early Childhood Development initiative, the Conservative government immediately tore up the agreements that the Government of Canada had signed with the provinces.

The commitment to further collaboration and cooperation in developing coordinated responses to infectious disease outbreaks and other public health emergencies has thankfully continued to take place because of the new Public Health Network co-chaired by Dr. David Butler Jones and Dr. Perry Kendal.

In spite of the commitment by the federal government for ongoing investments for needed vaccines through the National Immunization Strategy and to provide new immunization coverage for Canadian children, the new Conservative Government sunsetted the funds for the new children’s immunizations and unilaterally decided to provide dollars for HPV vaccine outside the collaborative process with all jurisdictions for prioritizing vaccines in the National Immunization Strategy.

Although governments committed to accelerate work on a pan-Canadian Public Health Strategy, there has been no progress since the election of the Conservative Government. In December 2005, Health Ministers approved the Health Goals for Canada as promised in the Accord. However, there has been no action on the necessary next step of choosing indicators and targets through a collaborative process with experts and stakeholders. The Strategy was to have increased efforts to address common risk factors, such as physical inactivity, and integrated disease strategies, yet the 300 million dollars dedicated to integrated disease strategies was used to fund individual diseases instead of funding work on common modifiable risks and social determinants of health. It is even difficult to assess whether there has been any support from the federal government for the First Ministers’ commitment to working across sectors through initiatives such as Healthy Schools.

Health Innovation

The First Ministers acknowledged a strong, modern health care system is a cornerstone of a healthy economy. The federal government commitment to continued investments to sustain activities in support of health innovation have not been realized. Investments in CIHR, Genome Canada have plateaued to a worrying level and support for bodies such as the Health Council of Canada and CIHI and Health Infoway are not sufficient to stimulate optimal innovation in health and health systems.

Accountability and Reporting to Citizens

All governments agreed to report to their residents on health system performance including the elements set out in this communiqué. Governments agreed to seek advice from experts and health providers on the most appropriate indicators to measures of health system performance. But without a common template for reporting and a process to develop common indicators the accountability to citizens is meaningless. The Saskatchewan reporting system could provide an excellent template. The Saskatchewan report presents the areas that are doing well, making good progress, and still providing challenges.

Even though the Communiqué funding arrangements required jurisdictions to comply with the reporting provisions of this communiqué, there have been no consequences for the lack of meaningful reporting.

Although the Health Council does prepare an annual report to all Canadians, on the health status of Canadians and health outcomes, the Council’s report is handicapped by the lack of good data. This year the Council has not even been able to provide a table comparing province by province results.

Dispute Avoidance and Resolution

Even though the provinces acknowledged their acceptance of the letters of 2002 with respect to Dispute Avoidance, the federal government has avoided disputes by pretending that none exist.

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Conclusion

This Review is akin to assigning a mark when the student skipped class all term and then didn’t even write the exam. When asked to prepare a report for the Standing Committee on Health on the federal perspective of progress to date on the Accord the Minister merely submitted other pre-existing reports. The Government has not only failed in its accountability to this Parliamentary Committee, it has failed the people of Canada.