HESA Committee Report

SUPPLEMENTARY REPORT OF THE NEW DEMOCRATIC PARTY OF CANADA

Addressing Canada’s Health Workforce Crisis

On February 9, 2022, the House of Commons Standing Committee on Health (HESA) adopted a motion to undertake a study on Canada’s health workforce crisis. This examination occurred in the unique context of a global pandemic that put unprecedented strain on Canada’s health care system and all those who devote their skills, talents and dedication to making it work.

Canada’s New Democrats thank all those who participated in this study. In addition, we wish to express our profound gratitude to health care workers across our country who sacrifice so much to take care of us when we need it most.

We think it is important to note that while the COVID-19 crisis exposed many weaknesses in our health care system, in many cases it did not cause them.  Without doubt, the COVID-19 pandemic created grueling conditions that are leading health care workers to burn out and leave the profession at unprecedented rates. However, most of the issues that have contributed to the health care human resources crisis have been decades in the making.

One conclusion is strong and clear: if we don't act now, we risk suffering a system-wide failure of our health care system.

The New Democratic Party of Canada endorses the Committee’s report and the twenty recommendations contained therein. However, we believe that it can be strengthened.  We therefore offer the following supplementary information and recommendations to address Canada’s health workforce crisis.

• A. Federal responsibility for health care

New Democrats believe it is vitally important to ensure that all levels of government play their part in ensuring high-quality health care is delivered in Canada. In our view, we will not successfully address any of the critical issues facing our health care system, including the human resources crisis, unless both federal and provincial/territorial governments are fully engaged.

It must be recognized that the Canadian Constitution does not expressly grant health care as an exclusive power either to the federal Parliament or provincial/territorial legislatures. Indeed, the Supreme Court of Canada has been clear that “health is not a matter which is subject to specific constitutional assignment but instead is an amorphous topic which can be addressed by valid federal or provincial legislation.”[1]

Although the provinces are responsible for the direct delivery of most medical services, establishment of hospitals and the regulation of professions, the federal government uses its spending power, grounded in sections 91 and 106 of the Constitution, to set conditions and criteria for federal health transfers. It also exercises jurisdiction through the criminal law power (used, for example, to regulate prescription medicines) and residually through the Peace, Order and Good Government authority.

Legislatively, the federal role is most commonly expressed via the Canada Health Act and the Federal-Provincial Fiscal Arrangements Act.  It is important to note that federal spending power is wider than the field of federal legislative competence and Parliament is empowered in appropriate circumstances (like emergencies) to disburse federal funds for use in areas within provincial jurisdiction.

This means that both senior levels of government in Canada – federal and provincial/territorial – have critical roles to play in ensuring high-quality, timely and equitable health care is available to all Canadians.

• B. Federal health care spending

Although the COVID-19 pandemic has undeniably placed enormous strain on our health care system, the roots of Canada’s health workforce crisis can be traced back to decades of poor policy choices at all levels of government and the steady erosion of financial contributions by successive federal administrations.

When Canada’s public health care system was first established, it was based on a 50/50 cost sharing partnership between the federal government and the provinces. However, over the years the federal contribution has declined to just 22 percent. While the federal government occasionally disputes this latter figure, it never denies that its share has fallen substantially below 50 percent.

This has profoundly shifted the fiscal burden for health care delivery and exacerbates pressures caused by an aging population, technological advancement, and increasingly expensive treatments and pharmaceutical drugs.

The results of this are clear to see on the frontlines of care.

Where Canada used to have 6.9 hospital beds per 1,000 people, we now have just 2.5. Millions of Canadians are unable to access a family doctor, the primary portal into our health care system. And Canada now ranks near the very bottom of the OECD in the number of physicians per capita and wait times for essential care.

• C. Public health care delivery

Alarmingly, the federal government’s eroding share of overall health care spending has led to an increase of private, for-profit delivery across the country, or calls for same. This has led to violations of the accessibility criterion of the Canada Health Act, with patients increasingly being inappropriately charged to access medically necessary health services at private clinics.

In addition, certain provinces are allowing faster access to essential diagnostic services, like MRIs, to those who can pay for same. This leads to inequity and preferential access to care based on wealth as those diagnostic results often translate into quicker surgery access for those patients, thus facilitating a form of “queue-jumping.”

Private clinics across Canada are also exploiting a loophole in the Canada Health Act to offer two-tier access to non-emergency surgeries. 

This loophole stems from the Act’s definition of an insured service: a medically necessary non-emergency surgery is only an insured service when an individual is in their province or territory of residence. However, if they visit another province or territory, non-emergency surgery is not insured and thus not subject to the Act’s conditions and criteria. This has led to private, for-profit clinics charging tens of thousands of dollars to Canadian patients desperate for care.

Some provincial governments have recently announced plans to expand private, for-profit delivery to address hospital overcrowding and unacceptably long waitlists for surgeries, diagnostics and other procedures. However, decades of evidence indicates that this approach will simply exacerbate the current crisis.

Most germane to the present study, we are deeply concerned that for-profit providers will divert health care workers from the public system and deepen the health care worker shortage that is already putting severe strain on the public health care workforce. This will increase the serious, widespread burnout that was reported by every health profession who testified before HESA and worsen the recruitment and retention issue in our public system. Private, for-profit care also leads to extended wait times for patients in the public system, once again already unacceptably long.

Economically, for-profit delivery has also been shown repeatedly to be inefficient, drive up costs, deliver worse outcomes, and make governments vulnerable to corporate ransom as resources are shifted from the public to private sectors. If it is expanded, we are concerned that the extra costs of private care will put added pressure on, and reduce resources in, the public system, in turn exacerbating the problems that lie at the core of the present workforce crisis.

It is simply a matter of the strongest evidence that public health care is more efficient, equitable and cost-effective than private, for-profit delivery. The solution to Canada’s health workforce crisis therefore lies in strengthening public care, rather than weakening it through privatization.

• D. Support staff and allied health professionals

Canada’s New Democrats acknowledge that the Committee did not receive testimony from health care support staff as part of this study, as well as from many allied health care professions. This represents a deficiency with the Committee’s report. However, we want to use this opportunity to highlight the immense value of their contributions to our health care system and emphasize the urgent need to address the challenges faced across Canada’s entire health workforce. Without the skills, talents, and contributions of all those whose physical labour and health care knowledge make our public health care system possible, Canadians would not enjoy the generally high level of care we are privileged to receive.

• E. List of supplementary recommendations

The New Democratic Party of Canada recommends:

RECOMMENDATION 1

That the government of Canada increase its share of overall health care spending, with the goal of returning to a full 50/50 funding partnership with the provinces and territories.

RECOMMENDATION 2

That the government of Canada make any additional health transfers to the provinces and territories conditional on public funding being directed towards public health care delivery.

RECOMMENDATION 3

That the Government of Canada strengthen federal powers under the Canada Health Act and the Federal-Provincial Fiscal Arrangements Act to better protect the integrity of our public health care system. This includes closing all loopholes that make private payment for services possible and bringing diagnostic services fully under public coverage.

RECOMMENDATION 4

That the Government of Canada provide dedicated funding to recruit, train and retain health care support staff in order to create more time and capacity for direct patient care.