Inquiry: The Need for the Federal Government to Collaborate with Provincial and Territorial governments in Order to Ensure the Sustainability of the Canadian Health Care System Senator Jane Cordy May 1st, 2014
On the Order:
Resuming debate on the inquiry of the Honourable Senator Callbeck, calling the attention of the Senate to the growing need for the federal government to collaborate with provincial and territorial governments and other stakeholders in order to ensure the sustainability of the Canadian health care system, and to lead in the negotiation of a new Health Accord to take effect at the expiration of the 2004 10-Year Plan to Strengthen Health Care.
Hon. Jane Cordy: Honourable senators, I am going to speak today on the inquiry addressing the growing need for the federal government to collaborate with provincial and territorial governments to ensure the sustainability of the Canadian health care system.
I would like to thank Senator Callbeck for initiating this debate and for the work she has done on the Social Affairs Committee on examining the health accord.
Federal leadership is required to assure equality in access and quality of health care across all Canadian jurisdictions. We all recognize that health care in Canada is a provincial, territorial and federal responsibility. However, federal guidance and leadership is necessary to prevent regional health care disparities from growing within a national system where jurisdictions are operating on their own and in many cases against each other. This can foster inequalities in health care services. All Canadians should have access to the health care services they need and it should not depend on where they live.
Whether it is by championing a new health accord or by some other means, the federal government cannot just walk away from its national health care responsibilities. Regrettably, on March 31 this year, the federal government has allowed the 2004 health accord to expire without any intentions of forging ahead with a new agreement. It has also discontinued funding the Health Council of Canada.
Instead, the federal government plans to follow through on massive health care cuts while also unilaterally changing the Canada Health Transfer formula with the provinces and territories to a per capita scheme that will disproportionately punish smaller provinces with larger rural population bases.
My province of Nova Scotia will be one of the provinces hardest hit by these health care reforms by the federal government. Every provincial and territorial government will see substantial federal health care funding cuts except for Alberta, which will actually see funding increased under the new Canada Health Transfer scheme.
The current health transfer formula incorporates population share and income level of a province or a territory. The new per capita formula will only take into account the number of residents living in a specific province or territory, completely ignoring such factors as income, demographics, geography or any other unique conditions of a province or territory. This narrow view of each province or territory's health care funding realities underlines the federal government's approach to federal-provincial-territorial relations. In other words, the federal government prefers to walk away and wash its hands of the health care issue and let the provinces and territories fight it out for themselves.
Nova Scotia is due to receive $23 million less this coming fiscal year under the new per capita health transfer formula. At a time when health care costs in Nova Scotia already account for an estimated 45 per cent of provincial spending, Nova Scotia would not be able to make up for the loss of funding brought on by the expiration of the health accord.
Nova Scotia has an aging population - the second-oldest in Canada. With an aging population comes a higher prevalence of chronic illnesses. Age and chronic illnesses are two major stress factors on our health care system. We also have a fairly ruralized population, which complicates delivery and also increases the costs of health care services. At a time when more federal assistance is needed, the federal government has chosen to walk away.
Prime Minister Martin understood that federal leadership was integral to bring together first ministers to strengthen health care services across Canada. His efforts led to the 2004, 10-year plan to strengthen health care. At that time, first ministers recognized that:
... improving access to care and reducing wait times will require cooperation among governments; the participation of health care providers and patients; and strategic investments in areas such as: increasing the supply of health professionals...; effective community based services, including home care; a pharmaceuticals strategy; effective health promotion and disease prevention, and adequate financial resources.
The federal government followed through with the commitment to inject $41 billion to provinces and territories for health care needs over the course of the 10-year accord. The money also came with conditions that the funding was to be used to tackle certain areas of health care system in need of reform.
As a member of the Standing Senate Committee on Social Affairs, Science and Technology, I had the pleasure to participate in the study to assess the progress of the 2004 health accord. The committee released its findings in April of 2012. Our findings were encouraging. Significant strides had been made in addressing wait times and the staffing levels of health service professions and overall access to health services was found to be improving. Although most witness testimony was positive, it was determined that there was still much room for improvement: specifically, pharmaceutical cost burdens, injury and disease prevention strategies, health care silos and general primary health care reform. Unfortunately, the improvement in wait times and staffing levels was attributed more to an infusion of funds than true reform and innovation as was intended. In order for progress to continue, the committee concluded:
... there is a need for federal leadership in promoting health- care reform across jurisdictions. For witnesses, federal investments in electronic health-record systems are critical to promoting the integration of different health-care sectors and promoting collaboration among health professionals, though there was a need to prioritize interoperability and uptake among health-care professionals. The committee also heard that they would result in increased accountability by allowing for the monitoring of quality and performance of health systems.
Our report also stated:
Though provinces and territories are primarily responsible for health-care delivery in Canada, the committee heard that it was important that the federal government, working in collaboration with the provinces and territories, take a leadership role in establishing a Canadian Health Innovation Fund that would identify and promote the adoption of best practices across health-care systems. Furthermore, it could ensure that its investments in research are resulting in innovation in health-care delivery across Canada.
Our report offered 46 recommends for the 2004 health accord moving forward. The writing seemed to be on the wall when the government responded to our committee's report and they didn't address a single recommendation presented by the committee, seeming to dismiss the committee's report altogether. It is not surprising that the federal government has now decided to abandon any leadership role in health care and has left the provinces and territories to go it on their own. As the Nova Scotia Citizens' Health Care Network stated:
The biggest impediment to progress in implementing the 2004 Health Accord has been the withdrawal of the federal government from the essential role of national coordination in health care policy. There is a deficit of political leadership in health care, especially at the federal level.
They go on to say:
Developing national approaches on health system issues and promoting the pan-Canadian adoption of best practices and innovation is the glue that keeps Medicare together. This role cannot be performed by provinces and territories alone. As a result of the vacuum in federal leadership, the health care system is fragmenting more than ever, into 14 separate systems operating independently from each other. This fragmentation undermines the core principles of the Canada Health Act, especially comprehensive coverage and portability between provinces and territories.
Canada's health care system, as well as the well-being of Canadians as a whole, requires the concerted effort and cooperation of all governments - provincial, territorial and federal. What is required is an engaged federal government, a federal government not content with walking away from the responsibilities that have historically made Canada such a strong federation.
We do have a Minister of Health and a health department at the federal level. Currently, federal-provincial relations are at what some have called a low point and others have called adversarial, but my hope is that this will change. I choose to believe there is a willingness on all sides to come together, because if all levels of government do not work together, it is the health of Canadians that will suffer.
It is my hope that the federal government will recognize the importance of their leadership role and will facilitate the necessary steps to bring first ministers together and will renegotiate new health agreements moving forward - agreements reached in consultation with the provinces and territories. Federal leadership should be used to lay the groundwork for true reform and innovation within the system. That is how our health care system will improve right across the country.