While recognizing the fact that each
jurisdiction in Canada is responsible for planning and management within its
own health care system, the Committee heard that there were numerous benefits
for collaboration across jurisdictions in HHR planning. National planning and
collaboration in HHR was seen by witnesses as necessary to prevent competition
between jurisdictions for the same health professionals, promote inter‑provincial
mobility for health professionals to address mismatches in supply and demand in
different areas across the country, and most significantly, witnesses
identified the need to share information regarding best practices in different
jurisdictions in addressing HHR challenges.
The current mechanism for pan-Canadian
planning and collaboration in HHR is the F/P/T Advisory Committee on Health
Delivery and Human Resources (ACHDHR). Created in 2002 by the F/P/T Conference
of Deputy Ministers of Health, the ACHDHR has a mandate to: provide policy and
strategic advice to the Deputy Ministers of Health on the planning,
organization and delivery of health services, including HHR, as well as provide
a national forum for discussion and information sharing. The ACHDHR is made up of representatives from all 14 governments, as well as
from the Health Action Lobby; representatives from First Nations communities;
the Council of Ministers of Education, Canada; the Canadian Institutes of
Health Research (CIHR); the Canadian Institute for Health Information (CIHI); a
regional health authority, and Human Resources and Skills Development Canada
(HRSDC).
In her appearance before the Committee, the
federal Co-Chair of the ACHDHR, outlined the initiatives undertaken by the
ACHDHR. In
2007, the ACHDHR released
A Framework for Collaborative Pan-Canadian Health Human Resources Planning, an
action plan with short, medium and long-term objectives in the following areas:
- planning for the optimal number, mix and distribution of health care
providers ;
- working closely with employers and the education system to
develop a health workforce that has the skills and competencies to provide safe
high quality care, work in innovative environments, and respond to changing
health care system and population health needs;
- achieving the appropriate mix of health care providers and deploy
them in service delivery models that make full use of their skills; and
- building and maintaining a sustainable workforce in healthy safe
work environments.
However, it is important to note that the Framework
has no hard targets in terms of increasing the supply of health care providers.
In addition to the Framework, the ACHDHR has
done a comprehensive update of an inventory of HHR forecasting models, as well
as convened workshops to share knowledge and promote collaborative data and
modeling activities to support jurisdictional policy and planning requirements.
They have further developed a committee to advise governments on whether
proposed changes in credentials for the entry-to-practice of health care
providers would serve the interests of patients, health care providers and
education systems. The ACHDHR has also taken an active role in addressing
internationally educated health care professionals (IEHPs) by endorsing a
business case for the development and implementation for a standard national
assessment for International Medical Graduates entering national postgraduate
medical training in Canada. Finally, the ACHDHR is also in the process of
developing a strategy to address gaps in the Canadian approach to
interprofessional education and collaborative practice.
Despite the various initiatives undertaken by
the ACHDHR, some witnesses appearing before the Committee articulated that it
was not providing an effective mechanism for national collaboration in HHR
planning. First, they found that the membership of the ACHDHR was not
inclusive, as it did not have representatives from the many different health professions
involved in collaborative health care. Second,
they indicated that implementation of the Pan-Canadian Collaborative Planning
Framework was slow and that the ACHDHR had not been successful in ensuring that
the Framework was receiving the attention and support it needed from
governments to be implemented. Most tellingly, some witnesses appearing before the Committee spoke of the need
for a national plan or strategy to address HHR challenges, but seemed unaware
of the existence the ACHDHR’s Framework.
Consequently, some witnesses called for the
expansion of ACHDHR’s mandate and membership “to include active participation
from stakeholders in order to have realistic and attainable goals” in HHR. However, they also argued in favour of establishing a new national observatory
on HHR which “would bring together researchers, governments, employers, health
professionals, unions, and international organizations to monitor and analyse
trends in health outcomes, health policy and HHR to provide evidence-based advice
to policy makers.” The
national observatory could further serve as a knowledge translation mechanism,
in which best practices in addressing HHR challenges would be shared among
stakeholders.
The Committee recognizes that the ACHDHR has
undertaken significant efforts in pan-Canadian HHR collaborative planning and
knowledge translation. However, it notes that the ACHDHR may need to focus
greater effort towards ensuring that A Framework for Collaborative Pan-Canadian
Health Human Resources Planning has the support necessary from both governments
and stakeholders to be implemented. The Committee also observes that neither
Health Canada’s Pan-Canadian Health Human Resource Strategy, nor
the ACHDHR’s Framework are linked to hard targets in terms of increasing
the supply of health professionals in Canada. The Committee recognizes that the
ACHDHR has undertaken steps to ensure that its membership is broad-based by
including the Health Action Lobby (HEAL), a coalition of national health and consumer
associations and organizations dedicated to protecting and strengthening Canada’s
publicly funded health care system. It also heard that the ACHDHR has recently established working groups devoted to
inter-collaborative practice and IEHPs. However, the Committee also
acknowledges that there may be a need to consider the creation of an additional
mechanism or national observatory on HHR that operates at arm’s length from F/P/T
governments, as suggested by witnesses. The Committee therefore recommends:
Recommendation 1:
That the F/P/T Advisory Committee on Health Care Delivery and Human
Resources to consider the feasibility and appropriateness of either expanding
its membership to include a wider range of stakeholders and broadening its
mandate to allow for the development of an inventory of data and research on
best practices in addressing HHR challenges in Canada; or establishing a new arm’s
length national observatory on health human resources with a broad-based membership
that would promote research and data collection on HHR; serve as an effective
knowledge translation mechanism; and identify key priorities for future
research.
Recommendation 2:
The ACHDHR report on the implementation of A Framework for
Collaborative Pan-Canadian Health Human Resources Planning, including progress
towards its short, medium and long-term objectives.
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