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HESA Committee Report

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Chapter 7: HHR needs and
challenges facing federal client groups

Introduction

As outlined in Chapter 2, the federal government has jurisdiction over specific population groups, including: First Nations and Inuit; immigrants; Canadian Forces; veterans; the RCMP; and federal inmates. As a result, it offers certain primary and supplementary health care services to approximately 1.3 million Canadians through six departments, including: Health Canada, Citizenship and Immigration Canada (CIC), Veterans Affairs Canada (VAC), Department of National Defence (DND), Correctional Service Canada (CSC) and the RCMP.[141] The overall cost to the federal government for the provision of these health services and related benefits is approximately $2.7 billion annually, making it the fifth largest health care provider in the country.[142]

While the types of health services and benefits that the federal government offers to each of these client groups varies substantially, these federal departments and agencies face common challenges related to HHR, including high vacancy rates in these professions. For example, in 2008, DND had a vacancy rate of 25% in its nursing positions, and CSC had a vacancy rate of 35% in their psychology positions.[143] These high vacancy rates have meant that federal departments and agencies have had to rely on third party contracts that pose significant financial burdens; the cost of DND’s third party contract for physicians was $26 million in 2007, while VAC’s was $6 million.[144] Moreover, the Committee was told that federal departments and agencies are limited in their ability to offer competitive salaries and benefits to health professionals due to the passing of the Expenditure Restraint Act, which limits annual increases in compensation for all professional and administrative personnel within the federal public service to 1.5%.[145]

This chapter examines how federal departments and agencies are addressing both individually and collectively the HHR challenges that they experience in providing services and benefits to meet the health needs of their respective client groups. It begins with an overview of horizontal collaboration in HHR through the Federal Healthcare Partnership (FHP), and then examines in detail the unique needs and challenges facing each of the respective federal client groups.

Horizontal Collaboration in HHR: The Federal Health Care Partnership

The Committee heard that the six departments and agencies responsible for health services and benefits for federal client groups work together to address their common HHR challenges through the FHP, a horizontal initiative that aims to achieve economies of scale in their health care responsibilities across the federal public service and serves as a forum to identify areas for joint collaboration in health care.[146] In response to the shortages in HHR facing federal departments, the FHP established the Office of Health Human Resources in order to coordinate collective recruitment and retention activities and provide leadership and assistance to the FHP member organizations when addressing common issues and challenges in the area of HHR.[147]

The Committee heard that since October 2008, the FHP Office of Health Human Resources has undertaken three strategies to address vacancy rates in health professions within the federal public service. First, the Office is working to address health service occupational classification and compensation issues by supporting the request of federal physicians to be removed from their current occupational classification levels and commissioning a study by Statistics Canada to compare federal physician compensation levels to those received by physicians in private practice.[148] Second, the Office is implementing HHR recruitment initiatives, including offering clinical placements and participating in job fairs and outreach activities, in order to promote the federal government as an employer of choice for health professionals.[149] Finally, the Office aims to promote communities of practice by serving as a functional community hub where federal health professionals can come together to network, share best practices and strengthen their community through training and collaboration.[150]

First Nations and Inuit

(i) Health Canada’s Roles and Responsibilities

Aboriginal peoples are defined in section 35 of Constitution Act, 1982, as the “Indian, Inuit and Métis peoples of Canada.”[151] Section 91(24) of Constitution Act, 1867 grants the federal government primary jurisdiction over First Nations and Inuit. The federal government has interpreted this responsibility as being limited to First Nations living on reserve and specific Inuit. Therefore, in accordance with the 1979 Indian Health Policy, the federal government provides certain health services and benefits to these population groups, which are now delivered primarily through Health Canada’s First Nations and Inuit Health Branch (FNIHB).[152]

FNIHB employs 800 nurses and home care workers who provide community-based health services to First Nations and Inuit communities across the country.[153] However, some First Nations and Inuit communities are responsible for the administration of these community-based health services through contribution agreements, or Health Service Transfer Agreements with FNIHB.[154] In addition to federal health care programs, on reserve First Nations and Inuit communities access medically necessary acute and primary care through hospital and medical services provided by their home province on the same basis as all other Canadians.[155]

(ii) Current Challenges in the Recruitment and Retention of Aboriginal Health Human Resources

The Committee heard that one of the main HHR challenges facing First Nations and Inuit communities is the recruitment of First Nations and Inuit into the health work force. According to the National Aboriginal Health Organization (NAHO), there is a disproportionate lack of Aboriginal health professionals in Canada.[156] For example, only 3.7% of health care professionals identify as Aboriginal in Saskatchewan, yet Aboriginal peoples represent 8.5% of the employed population in that province.[157] Furthermore, according to the 2006 Census, only 240 people who identified as First Nations had graduated in medicine, veterinary medicine, or dentistry.[158] The Committee heard that increasing the number of Aboriginal health professionals was essential to improve the retention of HHR in on reserve First Nations and Inuit communities, as health professionals of Aboriginal background are more likely to return and remain in their communities due to family ties and kinship networks.[159] Moreover, they are also able to provide on reserve First Nations and Inuit communities with culturally appropriate care.[160]

However, witnesses explained that there were numerous barriers to recruiting First Nations and Inuit into the health workforce. Primarily, many First Nations and Inuit lacked the education necessary to pursue health careers, as high school completion rates for these population groups are disproportionately lower than the rest of the Canadian population.[161] According to the 2001 Census, 16% of Canadians aged 20 to 24 had not completed high school. However, among Aboriginal Canadians in the same age group, 43% did not have a high school certificate.[162] The Committee heard that in Quebec, only 3% of First Nations meet the requirements to access post-secondary education.[163] For those who succeeded in accessing post-secondary education, many further lacked the necessary background in mathematics and sciences to pursue health careers.[164]

In addition, the Committee heard that First Nations and Inuit often face funding barriers in pursuing post-secondary education in the health sciences. Though scholarships and bursaries are available, witnesses articulated that funding arrangements often do not take into account the unique needs of First Nations and Inuit students, including: lengthier and interrupted educational careers due to factors such as family obligations and participation in transitional programs.[165]

Finally, the Committee heard that First Nations and Inuit students experience cultural, social and geographic barriers in pursuing the post-secondary education in the health sciences. Some First Nations and Inuit students have difficulties gaining proficiency in the language of instruction.[166] They also continue to be educated in environments, where many health professionals do not have knowledge of their cultural practices, or respect for the contributions that traditional medicine has made to health care.[167] Many First Nations and Inuit students must pursue their post-secondary education in locations where they are distant from their own communities and social support systems for extended periods of time, leading to further isolation.[168]

According to witnesses, on reserve First Nations and Inuit communities also encounter challenges related to the retention of HHR due to a lack of funding. The Committee heard that on reserve First Nations and Inuit communities had difficulty retaining health professionals, because the pay scales offered by the federal government could not compete with those offered by other health service providers.[169] In particular, the Committee heard that Aboriginal physicians carry high debt loads from their education and training and therefore are reluctant to return to their home communities to practice for lower salaries.[170] Similarly, the Committee heard that on reserve First Nations and Inuit communities face HHR shortages because they are not provided with sufficient base funding from Health Canada to hire the health human resources necessary to meet their growing population needs.[171] The Committee heard that despite their increasing population, Health Canada had only provided on reserve First Nations and Inuit communities with one additional nurse, as part of their nursing transformation strategy in 2004.[172]

Difficult social conditions in on reserve First Nations and Inuit communities are another factor affecting the retention of health professionals in these communities, as one witness told the Committee:

We were talking about the experience of one of my students in the nursing program. She’s from Onion Lake on the Alberta-Saskatchewan border, and I asked her if she was going back when she said she’d done nursing school. She said ideally she’d love to, but the reality is she’s going to stay in an urban centre until her kids are done school, because she doesn’t want them to struggle the way she is struggling in the maths and sciences.[173]

The Committee also heard that Aboriginal physicians experience higher levels of burnout due to the stressful nature of the work in rural and remote locations and the multiple roles that they play as advocates for their communities.[174]

(iii) Strategies to Improve the Recruitment and Retention of Aboriginal Health Human Resources in First Nations and Inuit Communities

The Committee heard that Health Canada had introduced the Aboriginal Health Human Resources Initiative (AHHRI) in 2005 with the overall goals of increasing the number of Aboriginal health professionals, as well as provide non-Aboriginal health professionals with the cultural knowledge and skills to provide appropriate care to Aboriginal population groups.[175] Provided with $100 million in funding over five years, Health Canada officials told the Committee that the AHHRI had succeeded in increasing the number of aboriginal students receiving bursaries and scholarships for health career studies to a total of 1,398 students over a four-year period from 2005 to 2009.[176]

In addition, the AHHRI has provided funding for the development of curriculum frameworks for medical and nursing schools to provide their students with the cultural knowledge and skills necessary to make them effective practitioners in treating Aboriginal peoples, as well as working in on reserve First Nations and Inuit communities.[177] These cultural curriculum frameworks are also necessary to provide Aboriginal students with a health science education that is relevant to their life experiences.

The AHHRI has also provided colleges and universities with funding to develop bridging programs that help Aboriginal students qualify for entry into health studies.[178] The Committee heard that bridging programs helped those who were unable to complete high school gain the knowledge and skills necessary to enter post-secondary education. These programs, in part, serve to address the low high school completion rates in on reserve First Nations and Inuit communities. The Committee heard that AHHRI was also supporting initiatives to raise awareness of the educational requirements necessary, in particular in mathematics and sciences, to pursue careers in the health sciences.

In terms of the retention of health professionals in on reserve First Nations and Inuit communities, the Committee heard that Health Canada, in its renewal of its AHHRI Initiative, will focus on providing increased training to community-based paraprofessionals and allied health professionals such as addictions workers, mental health, diabetes, maternal and child health workers, and home community care workers, in order to enhance their capacity to provide health services and support to health professionals working with those communities.[179] The Committee also heard that Health Canada was working with the Assembly of First Nations to determine the necessary funding required to address the lower pay scales offered to HHR in on reserve First Nations and Inuit communities.[180]

Witnesses appearing before the Committee articulated that AHHRI is providing welcome support to programs and organizations working towards increasing the number of Aboriginal HHR in Canada. They stressed the importance of funding bridging programs for Aboriginal students, which include support such as counseling, mentoring and dedicated places where Aboriginal students can interact with each other, problem solve and maintain a sense of community throughout their education.[181]

Witnesses also highlighted the importance of community outreach activities to encourage the pursuit of health careers among Aboriginal youth. For example, the Committee heard about a program in Quebec, funded jointly by the federal and provincial governments, where representatives from the First Nations of Quebec and Labrador Health and Social Services Commission visit First Nations and Inuit high school students in their communities to educate them about the prerequisites and the procedures to attend university in the health sciences.[182] The students are then able to visit the university campuses and meet with university students to learn about university life.

While witnesses were supportive of Health Canada’s AHHRI, they expressed concerns about funding. First, witnesses articulated that although AHHRI’s funding had been extended for another two years until 2012, this was not a reasonable period of time to make significant improvements in increasing the number of Aboriginal health professionals. As they noted, “it takes a minimum of nine years to train a physician.”[183]

Second, witnesses articulated that AHHRI did not provide funding to organizations in a manner that would enable them to sustain their activities.[184] The Committee heard that organizations, which play leadership roles in promoting health careers among Aboriginal peoples through the establishment of outreach and mentorship programs, conferences, and the development of curriculum in cultural competence and safety, such as the Indigenous Physicians Association of Canada, the Aboriginal Nurses Association of Canada and the National Aboriginal Health Organization, only receive project based funding rather than core operations funding through the AHHRI. As these organizations do not have other major sources of funds, they have difficulty maintaining their operations beyond the project for which they have received funding. They therefore recommended that Health Canada move towards funding core operations rather than a project-based funding model.

Finally, witnesses stressed the need for more scholarships and bursaries to be made available to First Nations and Inuit students pursuing health careers, with some funding targeted towards skills upgrading.[185] Some suggested that this could be done by increasing the funding provided through Indian and Northern Affairs Canada (INAC)’s Post-Secondary Support Program, which provides funding for tuition for eligible Status Indians[186] and Inuit.[187]

(iv) Committee Observations

The Committee recognizes the importance of increasing the number of Aboriginal HHR as part of the Government of Canada’s overall efforts to improve health outcomes for on reserve First Nations and Inuit communities. The Committee learned that many of the barriers to increasing the number of Aboriginal health professionals were deeply rooted in socio-economic factors, including: low levels of educational attainment and the inability to afford post-secondary education. However, the Committee heard that there were many successful initiatives funded through Health Canada’s AHHRI that helped mitigate some of these challenges, including: scholarship and bursaries, as well as bridging, outreach and mentoring programs. The Committee also heard that these programs require secure and sustained funding in order to succeed. The Committee is also aware that on reserve First Nations and Inuit communities face numerous challenges related to HHR retention, including: shortages, burnout and a lack of funds to pay market rates for health professionals. The Committee heard that some of these challenges could be addressed through the utilization of a broad range of health professionals, such as midwives, traditional healers, community health representatives and health promotion experts. However, the Committee recognizes that it is important to encourage Aboriginal health human resources to work in all areas of the health care system, including: teaching indigenous heath in university faculties, providing health care to Aboriginal populations living in urban centers, providing tertiary care, and developing Aboriginal health policy.[188] The Committee therefore recommends:

Recommendation 17:

That Health Canada provide secure and stable funding for Aboriginal Health Human Resources, including support for programs and initiatives such as: bridging, mentoring and outreach programs; scholarships; organizations providing leadership in this area; and initiatives supporting the recruitment and retention of a broad range of health professionals including: midwives, community health representatives, traditional healers, health promotion experts, and addiction counsellors.

Recommendation 18:

That Health Canada review its project-based funding model under the Aboriginal Health Human Resources Initiative to determine whether it is meeting the needs of stakeholders and on reserve First Nations and Inuit communities;

Recommendation 19:

That Health Canada continue to increase its focus on retention of health professionals in on reserve First Nations and Inuit communities, while respecting the institutions and initiatives already in place; and in particular, addressing issues related to cultural concerns and the pay scale of health professionals in those communities.

Recommendation 20:

That Health Canada consider enhancing its collaboration with Indian and Northern Affairs Canada, other relevant departments, and organizations such as: Indigenous Physicians Association of Canada, the Aboriginal Nurses Association of Canada and the National Aboriginal Health Organization, to promote careers in health sciences at all education levels, including: primary, secondary and post-secondary education.

Other Federal Government Client Groups

(i) Royal Canadian Mounted Police (RCMP)

The RCMP is responsible for the health care of its members under the authority of the Royal Canadian Mounted Police Act.[189] As such, members of the RCMP are excluded from the Canada Health Act. The Committee heard that there are two dimensions to the health care benefits and services that the RCMP offers to its members. First, comprehensive health care is provided to members through health insurance benefit and entitlement programs offered by the RCMP, where members receive health care from health care professionals in the community, which are chosen by the individual, but paid for by the RCMP.[190] If necessary, the RCMP will arrange for travel or relocation in order for a member to receive adequate health services when they are not available in the community. As such, the RCMP does not provide direct health care or treatment to its members.[191]

Second, the RCMP is also responsible for the occupational health and safety of its members.[192] In support of this mandate, the RCMP’s occupational health and safety branch establishes policies and programs aimed at promoting a healthy and safe work environment, which includes developing national medical and psychological health standards. The occupational health and safety branch is responsible for monitoring the health of regular members throughout their career through its regional divisions. This is done through a mandatory periodic health assessment, which is completed by a division physician, who evaluates the member’s physical and mental well-being every one to three years. In order to further promote health and wellness among its members, the Committee heard that the RCMP had established the position of director general of workplace development and wellness on April 1, 2010, who is tasked to develop a wellness strategy for the RCMP.[193]

The Committee heard that the HHR challenges facing the RCMP were related to occupational health and safety. Witnesses appearing before the Committee spoke to the enormous physical, emotional and psychological difficulties that members of the RCMP face as result of their work, as “they are regularly exposed to traumatic events, tragedies, atrocities, natural disasters and deep human suffering.”[194] As a result, many develop operational stress injuries (OSI), which can be defined as any persistent psychological difficulty resulting from operational service and can include diagnosed medical conditions such as anxiety, depression and post-traumatic stress disorder (PTSD).[195] The Committee heard that OSIs, when left undiagnosed, can have a significant impact on functioning and well-being of an individual, which could include behavioural changes, depression and suicide.[196]

According to witnesses appearing before the Committee, the RCMP lacked the health human resources necessary to address OSIs among its members. The Committee heard that the physicians that conducted physical and mental assessments of the members of the RCMP were often employed on contract seven days per month and had little knowledge of the police profession or tools to diagnose symptoms of OSIs.[197] The Committee heard that the RCMP employed 14 psychologists, but they were employed to work with special police units rather than to provide counselling for members of the RCMP.[198] Finally, the Committee heard that there was insufficient follow-up and case management of those diagnosed with OSIs and were receiving treatment within the community, including data collection.

In order to address this situation, witnesses articulated that the occupational health and safety branch required a stable budget that took into account the increasing need to diagnose OSIs among members of the RCMP.[199] Health professionals needed specific training in the culture and experiences of members of the RCMP, as well as tools to recognize the symptoms of OSIs.[200] They further articulated that the RCMP could hire clinical psychologists with expertise in dealing with victims of trauma.[201] They also suggested that members of the RCMP have access to the same benefits and services as some of the other members of the Federal Healthcare Partnership (FHP), such as Veterans Affairs Canada’s (VAC) Veteran’s Independence Program (VIP), which provides home care services to veterans and their families.[202] Finally, witnesses also stressed the need for a cultural change within the RCMP that would encourage members to come forward when dealing with mental health issues.[203]

(ii) Canadian Forces

The National Defence Act grants the Minister of Defence authority over the management and direction of the Canadian Forces.[204] The Minister, in turn, has given the Canadian Forces Health Services (CFHS) responsibility for the management and direction of health care delivery to the Canadian Forces.[205] As members of the Canadian Forces receive health care from the federal government, they are also excluded from the Canada Health Act.

The Committee heard that CFHS operates as its own health jurisdiction, providing members with health services that include: primary and tertiary care, its own health training, dental service, public and occupational health, pharmaceutical supply systems, health research, and specific health teams to support military operations. These health services are provided by military members of the Canadian Forces, as well as civilian health professionals.[206]

According to officials appearing before the Committee, the CFHS began experiencing severe health personnel shortages in the 1990s.[207] This led to the development of the Rx2000 project in 2000, which aimed to improve recruitment and retention of health professionals in the military through the provision of competitive recruitment incentives, compensation scales, continuing medical education opportunities, and employment opportunities in other work environments.[208]

In addition, Rx2000 introduced primary health care reform into the military, focusing on the development of patient-centered practice, collaborative practice, and continuity in care. The Committee heard that the Canadian Forces’ collaborative health care model includes a broad range of health professionals, including: physicians, nurse practitioners, physician assistants, physiotherapists, and clinical and population health specialists. This collaborative health model has also been extended to mental health, where psychologists, psychiatrists, mental health nurses, social workers and pastoral counsellors all work together to treat the patient.[209] Officials also noted that this health care reform was further facilitated by the development of a health information system, including electronic health records for members of the Canadian Forces.[210]

Despite the success of the Rx2000 initiative, which has resulted in the CFHS meeting most of its health human resource needs, some gaps remain. The Committee heard that the CFHS has difficulty recruiting pharmacists, as there are general shortages in this profession and they demand high salaries. Furthermore, the recruitment of civilian health professionals remains challenging because of the disparities in salaries offered by the public service in comparison with private practice. Consequently, the CFHS is still forced to rely on contracted services, which are able to charge fees that are between 130% and 200% higher than those paid under provincial health care insurance plans.

(iii) Veterans Affairs Canada

In recognition of the service and contributions of former members of the Canadian Forces, the VAC offers certain health insurance benefits and rehabilitation services to veterans to ease their transition into civilian life. These health benefits and services are legislated through the Canadian Forces Members and Veterans Re-establishment and Compensation Act, 2005, which is commonly referred to as “The New Veterans Charter” and regulations under the Department of Veterans Affairs Act.[211]

VAC employs various health professionals in different capacities in support of its health insurance benefits and rehabilitation programs.[212] First of all, VAC employs health professionals in order to administer its health benefits and service programs, rather than provide direct health care to its clients. In addition, it employs a broad range of health professionals to provide direct health care delivery to clients receiving treatment and rehabilitation services through the department’s operational stress injury clinics and Ste. Anne’s Hospital, which it also manages. These health professionals are responsible for providing a wide range of health services, including: addressing veterans’ physical, psychological and social needs, providing both palliative care and treatment for dementia, pain management and operational stress injuries.[213] In total, the Department’s full complement of health professionals includes 377 nurses, 51 medical officers, and 57 contract occupational therapists.[214] The Department has also established an extensive network of clinical care managers, occupational therapists, psychoeducators, psychiatrists, psychologists and social workers to provide support and treatment to clients with complex mental health needs.[215]

Though officials from VAC were unable to appear before the Committee, they submitted a written brief outlining their HHR challenges. VAC’s statement articulated that the department was facing projected vacancy rates of 25% for nurses and 55% for medical officers by 2014 due to retirements and shortages in the overall health work force across the country.[216] Their brief further outlined HHR challenges specific to the department, including:

  • a complicated and protracted staffing process that discourages candidates from applying;
  • the perception among physicians that compensation in the federal public service is not on a par with that of the private fee for service structures;
  • difficulties finding bilingual health professionals to provide clients with services in their language of choice; and
  • the need for stable funding for professional development opportunities.

They further outlined their efforts in addressing these issues. In order to improve their hiring processes, they now contact candidates upon receipt of their applications and as follow up to interviews. They have changed the interview approach and invested in marketing strategies to make health professionals more aware of employment opportunities at VAC. They also offer research opportunities to employees in partnerships with universities, international bodies and the Canadian Institutes of Health Research (CIHR), in the area of military trauma and mental health issues.

(iv) Federal Inmates

In accordance with the Corrections and Conditional Release Act, Correctional Service Canada (CSC) is responsible for providing federal inmates with essential health care and reasonable access to non-essential mental health care that will contribute to the inmate’s rehabilitation and successful reintegration into the community.[217] As such, federal inmates are also excluded from the Canada Health Act, while serving their sentences within federal penitentiaries. CSC aims to provide essential health services that are comparable to provincial and community standards. Health services are provided to federal inmates through 52 health centres across Canada and four regional hospitals that are managed by CSC’s Health Services Sector.[218]

The Sector employs approximately 800 staff in a wide range of health professions, including: nurses, physicians, pharmacists, psychologists, epidemiologists and social workers.[219] However, health service delivery is carried out primarily by nurses with physician services provided on contract.[220] Furthermore, CSC’s Health Services Sector represents the largest federal employer of both nurses and psychologists.[221] These health professionals are responsible for providing health care to high risk offenders with complex and diverse health needs that include: mental illness, drug and alcohol addition, anger and violence.[222]

Officials appearing before the Committee indicated that CSC faced numerous HHR challenges, including shortages in particular health professions. The Committee heard that CSC has vacancy rates of 20% in psychology positions, 6% in nursing positions and 11% in social work positions.[223] In addition to the common HHR challenges faced by other federal departments, including the aging workforce and compensation issues, officials indicated that many health professionals were unwilling to work in their health centres in rural and remote areas.[224] Furthermore, as health professionals are regulated provincially, officials indicated that they had difficulties transferring staff between institutions located in different provinces.[225] This represented a particular challenge for the department in relation to nurses and psychologists. Finally, officials articulated that the stress of providing health care to federal offenders with complex physical and mental health care needs also served as a deterrent for the recruitment and retention of health professionals.[226]

The Committee heard that CSC implemented a recruitment and retention strategy in 2008 to address its HHR issues. As a result of this strategy, CSC has produced a series of materials aimed to promote health careers in CSC, as well as published articles in professional journals highlighting the work of their psychologists.[227] In addition, CSC has developed internship and practicum opportunities for physicians, psychologists and other health professionals, which have resulted in positions for some of these individuals.[228] Finally, CSC has also focussed on retention issues by investing $8 million to support the training and development of nurses and providing psychologists with dedicated annual funding for professional development.[229]

(v) Immigrants and Refugees

Citizenship and Immigration Canada (CIC) through its Health Management Branch is responsible for the health aspects of immigration, including the health assessments of those seeking to immigrate to Canada, and the provision of certain health services and benefits to refugee protection claimants. Under section 38(1) of the Immigration and Refugee Protection Act, CIC is mandated to assess applicants for permanent and temporary residency according to three grounds for health inadmissibility: danger to public health, danger to public safety and excessive demand on health or social services.[230] It does so by selecting and training medical practitioners, who are based worldwide, to perform international medical examinations, which evaluate the health of potential permanent and temporary residents.[231]

In addition, the Health Management Branch provides health benefits and services to refugee protection claimants, Convention refugees, persons detained for immigration purposes, victims of trafficking in persons and dependents of these groups. This is done on humanitarian grounds through its Interim Federal Health (IFH) Program, which is a health insurance program managed by a third party insurance company.[232] Based upon a 1957 Order in Council, the IFH Program is intended to provide urgent and essential health services to the aforementioned groups, who are unable to pay for such services on their own.[233] IFH benefits include basic health services similar to what is provided to other Canadian citizens and residents through provincial health plans, as well as supplemental health services that are offered to persons on social assistance in varying provinces such as dental care; essential prescription medications; and vision care.[234]

Officials appearing before the Committee articulated that as CIC provided its health services through the IFH Program, its roles and responsibilities were related to the management of this insurance program rather than to health care delivery. As such, they do not have a direct role in issues related to the recruitment and retention of health human resources. However, they indicated that many of the increases in costs associated with the IFH Program were related to challenges in health care delivery in provincial and territorial health care systems, including gaining access to health care providers.[235]

(vi) Committee Observations

The Committee believes that the federal government has a leadership role to play in addressing key HHR challenges facing the population groups for which it has direct responsibility. However, the Committee also recognizes that federal government departments and agencies face unique challenges in delivering health care to these population groups, as many have complex health needs particularly in the area of mental health. While the Canadian Forces and Veterans Affairs Canada have established innovative strategies to provide the HHR necessary to treat mental health problems, the Committee also heard that in deployment situations members of the Canadian Forces did not have access to clinical psychologists, only psychiatrists due to the size constraints of deployment forces.[236] In addition, the RCMP has only just begun to develop its own wellness strategy to address the mental health needs of their members. Meanwhile, Correctional Service Canada continues to face difficulties in reducing the vacancy rates for its psychology positions.

The Committee heard that these federal departments and agencies were cooperating in the context of the Federal Health Care Partnership to address common problems related HHR, including: compensation issues and recruitment and retention. The Committee believes that the members of the Federal Health Care Partnership could also work together in this forum to address common HHR issues and share best practices related to the provision of mental health care treatment and supports, including: case management, data collection, the recruitment and retention of mental health professionals, and tools for mental assessment.[237] The Committee therefore recommends:

Recommendation 21:

That the Federal Health Care Partnership ensure that its Mental Health Working Group has sufficient funds to undertake collaboration in addressing common health human resource issues related to the provision of mental health care treatment and support, including: case management, the recruitment and retention of mental health professionals, and tools for mental health assessment.

Recommendation 22:

That the RCMP continue to enhance the following components of its workplace development and wellness strategy: case management and data collection, training of health care professionals in the experiences of members of the RCMP, development of mental health assessment tools, the recruitment and retention of mental health professionals with expertise in trauma.


[141] Government of Canada, “FHP Office of Health Human Resources: Welcome! Working in the Federal Public Service,” http://www.fhp-pfss.gc.ca/fhp-pfss/ohhr-brhs/home-accueil.asp?lang=eng.

[142] House of Commons Standing Committee on Health, Evidence, No. 4, 3rd Session, 40th Parliament, 2010, March 23, 2010, /content/Committee/403/HESA/Evidence/EV4370667/HESAEV04-E.PDF, p. 6.

[143] Ibid.

[144] Ibid.

[145] Federal Healthcare Partnership, “FHP & The Office of Health Human Resources,” Brief submitted to the House of Commons Standing Committee on Health, March 23, 2010, p. 7.

[146] Ibid.

[147] Government of Canada, ”FHP: Office of Health Human Resources: About Us”, http://www.fhp-pfss.gc.ca/fhp-pfss/ohhr-brhs.asp?lang=eng&cont=501.

[148] Federal Healthcare Partnership, “FHP & The Office of Health Human Resources,” Brief submitted to the House of Commons Standing Committee on Health, March 23, 2010, p. 8.

[149] Ibid, p. 9.

[150] House of Commons Standing Committee on Health, Evidence, No. 4, 3rd Session, 40th Parliament, March 23, 2010, /content/Committee/403/HESA/Evidence/EV4370667/HESAEV04-E.PDF, p. 7.

[151] The Constitution Act, 1982, being Schedule B to the Canada Act 1982 (U.K.), 1982, c. 11, Part II, s.35 (2).

[152] Health Canada, “About Health Canada: Indian Health Policy 1979,” http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/poli_1979-eng.php.

[153] Health Canada, “First Nations and Inuit Health: Health Care Services,” http://www.hc-sc.gc.ca/fniah-spnia/services/index-eng.php.

[154]          Ibid.

[155] Commission on the Future of Health Care in Canada, “Building on Values: the Future of Health Care in Canada,” November 2002, http://www.healthcoalition.ca/romanow-report.pdf, p. 217.

[156] House of Commons Standing Committee on Health, Evidence, No. 5, 3rd Session, 40th Parliament, March 25, 2010, /content/Committee/403/HESA/Evidence/EV4378648/HESAEV05-E.PDF, p. 5.

[157] Ibid.

[158] Ibid.

[159] House of Commons Standing Committee on Health, Evidence, No. 5, 3rd Session, 40th Parliament, March 25, 2010, /content/Committee/403/HESA/Evidence/EV4378648/HESAEV05-E.PDF, p. 11.

[160] Ibid.

[161] Ibid. p. 4.

[162] Michael Mendelson, “Improving Primary and Secondary Education on Reserves in Canada,” Caledon Institute of Social Policy, October 2006, http://www.caledoninst.org/Publications/PDF/608ENG%2Epdf, p. 1

[163] House of Commons Standing Committee on Health, Evidence, No. 5, 3rd Session, 40th Parliament, March 25, 2010, /content/Committee/403/HESA/Evidence/EV4378648/HESAEV05-E.PDF, p. 4.

[164] Ibid.

[165] Ibid, p. 9.

[166] Ibid, p. 4.

[167] Ibid, p. 5.

[168] Ibid, p. 4.

[169] Ibid, p. 10.

[170] Ibid.

[171] Ibid, p. 7.

[172] Ibid.

[173] Ibid, p. 18.

[174] Ibid, p. 20.

[175] House of Commons Standing Committee on Health, Evidence, No. 41, 2 nd Session, 40th Parliament, November 2, 2009, /content/Committee/402/HESA/Evidence/EV4198199/HESAEV41-E.PDF, p. 2.

[176] Ibid.

[177] Ibid, p. 7.

[178] Ibid.

[179] House of Commons Standing Committee on Health, Evidence, No. 17, 3rd Session, 40th Parliament, May 13, 2010, /content/Committee/403/HESA/Evidence/EV4531758/HESAEV17-E.PDF.

[180] Ibid.

[181] House of Commons Standing Committee on Health, Evidence, No. 5, 3rd Session, 40th Parliament, March 25, 2010, /content/Committee/403/HESA/Evidence/EV4378648/HESAEV05-E.PDF, p. 13.

[182] Ibid, p .14.

[183] Ibid, p. 2.

[184] Ibid, p. 8.

[185] Ibid, p. 17.

[186] Registered (Status) Indian: those people who are registered or entitled to be registered as Indians in accordance with the provisions of the Indian Act. Tonina Simeone, “Federal-Provincial Jurisdiction and Aboriginal Peoples” February 1, 2001, Library of Parliament Publication TIPS-88E, http://lpintrabp.parl.gc.ca/apps/tips/tips-cont-e.asp?Heading=14&TIP=95.

[187] House of Commons Standing Committee on Health, Evidence, No. 16, 3rd Session, 40th Parliament, May 11, 2010, /content/Committee/403/HESA/Evidence/EV4515830/HESAEV16-E.PDF.

[188] Ibid, p. 18.

[189] House of Commons Standing Committee on Health, Evidence, No. 4, 3rd Session, 40th Parliament, March 23, 2010, /content/Committee/403/HESA/Evidence/EV4370667/HESAEV04-E.PDF, p. 3.

[190] Ibid.

[191] Ibid.

[192] Ibid.

[193] Ibid, p. 4.

[194] Ibid, p. 3.

[195] Ibid.

[196] Ibid. p. 3-5.

[197] Ibid, p. 2.

[198] Ibid, p. 16.

[199] Ibid, p. 12.

[200] Ibid, p. 4.

[201] Ibid, p. 9.

[202] Ibid, p. 9.

[203] Ibid, p. 15.

[204] DND, “Canadian Forces Health Services,” http://www.forces.gc.ca/health-sante/default-eng.asp.

[205] Ibid.

[206] House of Commons Standing Committee on Health, Evidence, No. 4, 3rd Session, 40th Parliament, March 23, 2010, /content/Committee/403/HESA/Evidence/EV4370667/HESAEV04-E.PDF, p. 5.

[207] Ibid, p. 5.

[208] Ibid.

[209] Ibid, p. 12.

[210] Ibid, p. 6.

[211] Veterans Affairs Canada, “The New Veterans Charter,” http://www.vac-acc.gc.ca/clients/sub.cfm?source=Forces.

[212] Veterans Affairs Canada, “Report to the House of Commons Standing Committee on Health,” Brief Submitted to the Committee, May 17, 2010.

[213] Ibid.

[214] Ibid.

[215] Ibid.

[216] Ibid.

[217] CSC, “The Standards for Health Care,” www.csc-scc.gc.ca/text/prgrm/fsw/hlthstds/healthstds5-eng.shtml.

[218] CSC, “Health Services Sector: Quick Facts,” August 2008, http://www.csc-scc.gc.ca/text/pblct/qf/15-eng.pdf.

[219] Ibid.

[220] House of Commons Standing Committee on Health, Evidence, No. 16, 3rd Session, 40th Parliament, May 11, 2010, /content/Committee/403/HESA/Evidence/EV4515830/HESAEV16-E.PDF.

[221] House of Commons Standing Committee on Health, Evidence, No. 16, 3rd Session, 40th Parliament, May 11, 2010, /content/Committee/403/HESA/Evidence/EV4515830/HESAEV16-E.PDF.

[222] Ibid.

[223] Ibid.

[224] Ibid.

[225] Ibid.

[226] Ibid.

[227] Ibid.

[228] Ibid.

[229] Ibid.

[230] Public Health Agency of Canada, Canadian Lung Association, Canadian Thoracic Society, “Canadian Tuberculosis Standards, 6th Edition,” http://www.phac-aspc.gc.ca/tbpc-latb/pubs/pdf/tbstand07_e.pdf, p. 312.

[231] Ibid, p. 314.

[232] House of Commons Standing Committee on Health, Evidence, No. 16, 3rd Session, 40th Parliament, May 11, 2010, /content/Committee/403/HESA/Evidence/EV4515830/HESAEV16-E.PDF.

[233] Public Health Agency of Canada, Canadian Lung Association, Canadian Thoracic Society, “Canadian Tuberculosis Standards, 6th Edition,” http://www.phac-aspc.gc.ca/tbpc-latb/pubs/pdf/tbstand07_e.pdf, p. 314.

[234] Ibid.

[235] Ibid.

[236] House of Commons Standing Committee on Health, Evidence, No. 4, 3rd Session, 40th Parliament, March 23, 2010 2010, /content/Committee/403/HESA/Evidence/EV4370667/HESAEV04-E.PDF, p.13

[237] In its annual report that was submitted to the Committee, the Federal Healthcare Partnership indicated that it had established a mental health working group to provide a forum for inter-organizational dialogue and information-sharing concerning mental health services, programs and policies. While the mental health working group held several meetings, the report articulated that the working group did not receive enough funding to undertake all of its planned activities. Government of Canada, Federal Healthcare Partnership, “FHS-PFSS Annual Report 2008-2009,” p. 18.