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Brief analytical summaries or syntheses #40

Time for Transformative Change: A review of 2004 Health Accord

Summary

Canada is no longer seen as a model of innovation in health care delivery and financing, says this report from the Standing Senate Committee on Social Affairs, Science and Technology. The committee’s review revealed that real systematic transformation of health care systems across the country had not yet occurred, despite more than a decade of government commitments and increasing investments. The committee made 46 recommendations it believes will truly transform the way health care professionals do business and will achieve lasting reform.

Background

On January 31, 2011, the Minister of Health requested that the Standing Senate Committee on Social Affairs, Science and Technology initiate the second parliamentary review of the 10-Year Plan to Strengthen Health Care (10-Year Plan), an agreement reached by First Ministers on September 16, 2004 that focuses on federal/provincial/territorial (F/P/T) collaboration in the area of health care reform.

This report presents the committee’s findings regarding progress towards the implementation of the 10-Year Plan and the Communiqué on Improving Aboriginal Health and identifies further actions that could be taken in support of the objectives outlined in these documents. It reflects the testimony presented by witnesses over the course of 13 hearings and one roundtable discussion, as well as many written submissions received from interested organizations and individuals.

Analysis and results

The key themes raised by these witnesses provide the basis and spirit of the recommendations outlined in this report. Witnesses emphasized to this committee the central importance of adopting a holistic understanding of health that sees physical and mental wellbeing as inextricably linked and equally important to the efficiency and quality of health care systems. This holistic concept of health has become a framing principle for this report. Witnesses also stressed that many of the factors that influence the health outcomes of Canadians lie beyond health care systems and are located in the social determinants of health, a point that is reflected most clearly in the poorer health status of Aboriginal peoples and the challenges children and youth face with respect to mental health and obesity.

Throughout the course of this study, witnesses were emphatic that health care reform could only be achieved by breaking down the different silos within health care systems. They insisted that different health care sectors such as primary, acute, continuing care and mental health services be integrated through common governance structures and funding arrangements and supported by seamless information systems. The integration of different health care professionals into primary health care teams requires the adoption of different methods of remuneration that allow for different health care professionals to work together. Furthermore, they underscored the vital importance of making patients’ needs and perspectives central to these reform efforts.

Witnesses provided exciting examples of reforms occurring at the front lines of health care delivery in Canada. However, they indicated that systemic change had stalled. When compared internationally, they noted that Canada is no longer seen as a model of innovation in health care delivery and financing. They therefore identified the need for specific mechanisms to promote the implementation of new practices in health care systems across the country. Otherwise, they feared that health care reform in Canada would never evolve beyond a pilot project.

Conclusion

The committee believes that it is important for governments to keep in mind that two years remain before the expiry of the 10-Year Plan in 2014. The committee’s review found that more progress needs to be made towards its objectives, in particular in the areas of primary care reform, establishing electronic health records, health human resources planning, and catastrophic drug coverage. However, the committee’s review revealed that real systematic transformation of health care systems across the country had not yet to occurred, despite more than a decade of government commitments and increasing investments. For witnesses appearing before the committee, the way forward was clear: long lasting transformative change could only occur through the breaking down silos between sectors within health care systems; facilitating collaboration among different health care professionals; adopting compatible health information systems; and establishing health governance and funding arrangements to support these developments. In addition, health care systems need to be reoriented towards the prevention of disease and injury; the needs of patients; and a holistic view of health, which sees physical and mental wellbeing as inextricably linked, while not forgetting that many of the factors that affect the health and wellbeing of Canadians remain outside of health care systems. Our witnesses spoke with conviction and experience. It is now time for us to act.

Implications and recommendations

Finally, many witnesses said that resources currently committed to federal, provincial and territorial health care systems are sufficient to provide Canadians with a high standard of quality health care, but they also told the committee that innovation-based transformation is needed to achieve and sustain these systems. These witnesses were unequivocal in their insistence that any increases in health care funding be used to promote change rather than maintain the status quo. They therefore argued that governments need to focus on creating incentives to transform health care systems. The committee heard that there is a real appetite among health care professionals to truly transform the way that they do business and achieve lasting reform. The committee believes that the time for this transformative change is now. It therefore recommends, among other things:

  •  That the committed annual increase in funding transferred from the federal government to the provinces and territories, through the Canada Health Transfer, be used by governments in great part to establish incentives for change that focus on transforming health-care systems in a manner that reflects the recommendations outlined in this report, and the overarching objectives of the 2004 10-Year Plan to Strengthen Health Care, including the need for measurable goals, timetables and annual public reporting through existing mechanisms.
  • That provinces and territories continue to develop strategies to address wait times in all areas of specialty care, as well as access to emergency services and long-term care, and report to their citizens on progress. 
  • That the federal government work with provinces, territories and relevant health-care and research organizations to develop evidence-based pan-Canadian wait-time benchmarks for all areas of specialty care that start when the patient first seeks medical help.
  • That the federal government work with provincial and territorial governments to develop a pan-Canadian vision statement that would foster a culture of patient-centred care in Canada through the establishment of guiding principles that would promote the inclusion of patient needs and perspectives in an integrated health-care-delivery process.
  • That the federal government, through its Foreign Credential Recognition Program, take the lead in working with provincial and territorial jurisdictions and relevant stakeholders to accelerate their efforts to improve the assessment and recognition of the foreign qualifications of internationally educated health professionals.
  • That the Government of Canada continue to invest in Canada Health Infoway Inc. to ensure the realization of a national system of interoperable electronic health records.
  • Recognizing the ongoing unique challenges associated with health and health care delivery in the North, that the federal government extend its funding of the Territorial Health System Sustainability Initiative beyond 2014 in a manner that is both sustainable and predictable.
  • That the federal government work with the provinces and territories to develop a national pharmacare program based on the principles of universal and equitable access for all Canadians; improved safety and appropriate use; cost controls to ensure value for money and sustainability; including a national catastrophic drug coverage program and a national formulary.
  • That Health Canada work with provincial and territorial partners to ensure equitable access to programs and initiatives related to improving Aboriginal health.
  • That the federal government work with the provinces and territories to address the social determinants of health, with a priority focus on potable water, decent housing and educational needs.

Source

Time for Transformative Change: A Review of the 2004 Health Accord