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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. 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.
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. 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. 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%.
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.
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. 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.
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. 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. 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.
Aboriginal peoples are
defined in section 35 of Constitution Act, 1982, as the “Indian,
Inuit and Métis peoples of Canada.” 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).
FNIHB employs 800 nurses and
home care workers who provide community-based health services to First Nations
and Inuit communities across the country. 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. 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.
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. 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. Furthermore, according to the 2006 Census, only 240 people who identified as
First Nations had graduated in medicine, veterinary medicine, or dentistry. 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. Moreover, they are also able to provide
on reserve First Nations and Inuit communities with culturally appropriate
care.
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. 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. The Committee heard that in Quebec, only 3% of First Nations meet
the requirements to access post-secondary education. For those who succeeded in accessing
post-secondary education, many further lacked the necessary background in mathematics
and sciences to pursue health careers.
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.
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. 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. 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.
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. 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. 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. 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.
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.
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.
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. 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.
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. 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. 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. 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.
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.
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. 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.”
Second, witnesses
articulated that AHHRI did not provide funding to organizations in a manner
that would enable them to sustain their activities. 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. 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 and Inuit.
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. 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.
The RCMP is responsible for the health care
of its members under the authority of the Royal Canadian Mounted Police Act. 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. 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.
Second, the RCMP is also responsible for the
occupational health and safety of its members. 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.
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.” 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). 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.
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. 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. 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. 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. They further articulated that the RCMP could hire clinical psychologists with
expertise in dealing with victims of trauma. 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. 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.
The National Defence Act grants the
Minister of Defence authority over the management and direction of the Canadian
Forces. 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. 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.
According to officials appearing before the
Committee, the CFHS began experiencing severe health personnel shortages in the
1990s. 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.
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. 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.
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.
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.
VAC employs various health professionals in
different capacities in support of its health insurance benefits and rehabilitation
programs. 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. In
total, the Department’s full complement of health professionals includes 377 nurses,
51 medical officers, and 57 contract occupational therapists. 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.
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. 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.
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. 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.
The Sector employs
approximately 800 staff in a wide range of health professions, including:
nurses, physicians, pharmacists, psychologists, epidemiologists and social
workers. However,
health service delivery is carried out primarily by nurses with physician
services provided on contract. Furthermore,
CSC’s Health Services Sector represents the largest federal employer of both
nurses and psychologists. 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.
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. 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. Furthermore, as health professionals are regulated provincially, officials
indicated that they had difficulties transferring staff between institutions
located in different provinces. 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.
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. 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. 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.
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. 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.
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. 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. 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.
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.
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. 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. 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.
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