HESA Committee Report

NDP Supplementary Report to the Standing Committee on Health’s Review of Progress on the 10-Year Plan to Strengthen Health Care, June 2008
by Judy Wasylycia-Leis, MP

As the driving force behind public health care in Canada, the NDP has had, from its very beginnings, a clear vision of a comprehensive, universal, non-profit health system where access to health services is based on need, not wealth.  We share ordinary Canadians’ pride at what we have achieved together so far and are committed to protecting and expanding that accomplishment.  We are now actively engaged in completing what Medicare founder Tommy Douglas called the “second phase” of public health care – broadening it to include other essential elements such as home care, drug coverage, long-term care and dental care and reorganizing it system-wide to more effectively deliver primary care and programs to prevent illness. 

The 2004 10-year Plan and the 2003 First Ministers’ Health Accord that spawned it came at a critical juncture in time.  Canadians had identified health care as their number-one priority, but were seeing it seriously eroded by underfunding and neglect.  Privatization pressures had been mounting and, with no federal government opposition, ‘privatization by stealth’ was spreading – for-profit clinics had emerged in several provinces along with a proliferation of supplementary fees.  The Canada Health Act was under attack by governments in Alberta and elsewhere, and the unilateral Liberal cutbacks of 1995 – the greatest single cut ever to our public health care budget – had played out in service cuts and personnel shortages leading to longer waits for medical procedures. 

The Romanow Commission had just reported on its extensive two-year study on the future of health care. With no government endorsement, concerns were mounting that this grand national undertaking to draft an evidence-based blueprint to save Medicare would be for nought.  There was an expectation that a significant government response was due.

The 10-year Plan was a call for renewal.  It recommitted governments at all levels to the principles of the Canada Health Act and to making strategic improvements in 10 key areas to strengthen health care.  To the extent that its objectives coincided with our vision of expanded, rejuvenated public health care, we welcomed the Plan.

How has the 10-year Plan lived up to that promise so far?  According to the Health Council of Canada, the body that tracks the Plan’s progress, not well overall.  The Health Council told the Committee “These accords have laudable, much needed and ambitious goals.  But have they had the broad national impact that government leaders intended?  In short, the answer is no.”  What’s wrong and how can we improve areas that are of priority concern?

National Pharmaceutical Strategy (NPS)

The growing use of drug therapies and their rise to the number one cost driver in health care has made bringing drug costs under the public health system a priority for the NDP.  The 10-year Plan’s National Pharmaceutical Strategy (NPS) includes steps in the right direction such as a focus on catastrophic drug coverage, expensive drugs for rare diseases, a common national formulary, pricing and purchasing strategies, and real world drug safety and effectiveness. An interim report with concrete steps for action was issued in June 2006.  It was endorsed by the provinces and territories, but waning federal government support for the NPS was immediately signalled when the federal Health Minister didn’t show up at the follow-up intergovernmental meeting.  This lack of federal interest and leadership continued, leaving the Report gathering dust and causing the Health Council to conclude “governments have not made substantial progress” in this area.  In fact, the Committee was told, the Conservatives are even working against the Plan by extending brand name patents and increasing, rather than reducing, provincial drug costs – not to mention animosity.  The result of this leadership void: drug costs rose to $27 billion in 2007 with about 60% still coming from people’s own pockets and private insurance.

Home Care

Home care is another NDP priority we had hoped the Plan would advance.  The Plan reiterates First Ministers’ previous recognition that home care is an essential part of health care.  (Romanow devoted a whole chapter to this “Next Essential Service”).  The Plan aims low at only two weeks of public coverage for acute and mental health services, along with end-of-life coverage.  Still, the Health Council told us, there remain “clear disparities in the availability of publicly-funded homecare across the country”, and that “few jurisdictions have considered any form of evaluation of their home care renewal efforts to date, or have any intent to monitor or report on accessibility and quality”. 

Again, the lack of federal leadership has been a key factor.  The Health Minister, ignoring the 80% of Canadians who want more home and community care added to the health system, has stated flatly that he is “not going to get involved” in home care because he sees it as a provincial matter.  As if to underscore his point, the government has dismantled the Secretariat set up in 2001 to coordinate the development of a national strategy on end-of-life care.  Meanwhile, a quarter of Canadians – mostly women –had to provide care to a family member or close friend last year, more than 40% of whom had to draw on their savings and 22% lose at least a month’s work to do so.

Wait times

The NDP had hoped, after its long fight to counter the devastating impact of Liberal mid-90so regain access to timely care.  In pockets across the country, there have b budget cuts, that the 10-year Plan would help Canadians teen some notable improvements within the public system and because of the public system where the reorganization of public resources has been turned to our advantage.  However, the Health Council reports that data for across-the-board comparisons and evaluations is still not available and that the benchmarks for the timing of diagnostic imaging are still not in place.  Again, despite incorporating wait times into the Conservative election platform, active federal leadership has been absent and this absence is costly.  The Conservative answer to failures to meet our national targets has been to simply ‘move the goal posts’, lessen the objectives.  Further, the government has been sitting on the report of the Wait Times Advisor for two full years.  Positive recommendations, including a more multidisciplinary approach and gender analysis, have been side-tracked. 

Just as damaging as this inaction, has been the federal government’s silence while for-profit forces have exploited public concern over wait times to resurrect their false promise of salvation through parallel for-profit care. Transferring health personnel from public to private systems would not add resources, just costs. It’s neither good math nor good public policy.  It does serve, however, to point to the growing personnel shortages throughout the health system – a problem that extends far beyond wait times. 

Health Human Resources (HHR)

For the NDP, addressing the urgent health human resourcing crisis is at the heart of preserving and strengthening public health care.  The skill shortage facing Canada’s health care system is critical and growing. No corner of care is unaffected and no region immune. For example:

• we’re graduating only 8,000 of the 12,000 nurses needed each year to keep up with attrition and population growth;
• we have the lowest doctor/population ratio in the G8 (an estimated 5 million Canadians don’t have a family physician).
• 50% of our medical lab technologists could retire by 2016; and
• we’re already short 100 full-time radiologists and predicting a shortage of 400 more by 2016.

The 10-year plan recognized this, but after developing the Framework for Collaborative Pan-Canadian Health Human Resources Planning, the action plan so urgently needed has hit the doldrums just when it should be energized by an active federal government.  The Health Council has said planning remains “fragmented” – “each province and territory does its own planning, without the benefit of pan-Canadian information needed for reliable decision-making”.  Provinces are left to compete for resources, as are smaller communities desperately trying to entice the basic health providers they need.  The extent of the problem is daunting and the need for a national strategy on human resourcing is urgent.  

Aboriginal health

The NDP vision for health care has always recognized, as a priority, the urgent need to address the health deficit faced by aboriginal Canadians with improvements to both health services and the determinants of health for aboriginal communities. The need for immediate government action -- particularly federal government action stemming from its direct responsibility for on-reserve First Nations and Inuit health – has been well outlined by the Royal Commission on Aboriginal Peoples, numerous reports by the Auditor General and countless others.  Although the 10-year Plan includes health care in Northern communities and has incorporated the 2004 Blueprint for Aboriginal Health, the Health Council reports that “preventable health problems… continue to be of concern across the country”, and that “relatively little funding seems to have flowed”.  Meanwhile, aboriginal health continues to fall behind with disproportionate rates of diabetes and other preventable diseases. Clearly there is an urgent need to mobilize the federal government action that has been missing.

Conclusion and Recommendations

Canadians care passionately about their public health care system and are depending on their governments to sustain and improve it.  Together, we have a lot riding on the success of this renewal effort.  In the course of the Committee’s review, we have identified the following key concerns and make recommendations to meet these concerns.

Federal leadership needed in a system-wide, pan-Canadian approach

We are concerned that the federal government’s decentralized approach to national health care priorities has resulted in the loss of a national vision for health care and a directionless, leaderless renewal process at the national level.

We recommend, therefore, that the federal government commit itself to a national, pan-Canadian, system-wide approach to public health care renewal anchored in Canada Health Act principles and enforcement, and with the jurisdictional flexibility and asymmetrical federalism found in the 10-Year Plan to Strengthen Health Care.

Urgent need to rekindle renewal effort

We are concerned that we are approaching the mid-way point in the 10-Year Plan to Strengthen Health Care and have been told by witnesses that insufficient progress being made to meet Plan objectives on time.

We recommend, therefore, that the government take urgent actions to get the Plan back on track in each of its areas of focus as quickly as possible, including:

• acting on the recommendations of the 2006 Interim Report of the National Pharmaceutical Strategy and the Report of the Wait Time Advisor;
• advancing the action plan under the Framework for Collaborative Pan-Canadian Health Human Resources Planning;
• energetically pursuing the objectives of the 2004 Blueprint for Aboriginal Health (most particularly where it relates to measures under direct federal jurisdiction);
• working with the provinces and territories to re-establish the Advisory Committee on Governance and Accountability as a functioning part of the renewal process; and
• convening a meeting of ministers of health to identify roadblocks that are impeding progress and to develop strategies to overcome these obstacles. 

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Fortifying the Canada Health Act

We are concerned that the Canada Health Act, our main tool in protecting public health care, to which the 10-Year Plan to Strengthen Health Care is committed, is being undermined through inadequate monitoring and enforcement.  The for-profit health industry continues to grow unabated undermining public health care and creating a two-tier health system by stealth.  The Canada Health Act annual reports to Parliament do not reflect this due to their limited scope and the government’s failure to make improvements identified by the Auditor General back in 2002. 

We recommend, therefore, that the Health Minister fully enforce the Canada Health Act by:

• setting data collection standards for reporting and enforcement that capture all for-profit activities that may impact on public health delivery;
• working collaboratively with the provinces and territories to fill gaps in reporting;
• stipulating that federal transfers should only be used for non-profit health care delivery; and
• removing any requirements that health infrastructure endeavours consider for-profit options such as public-private partnerships.