Health care transformation is needed next

Posted on February 13, 2023 in Health Delivery System

Source: — Authors: – Opinion/Editorials
Feb. 11, 2023.   By Star Editorial Board

Old habits die hard. With Canadians demanding our leaders act on health care, show some leadership and work collectively to transform a crumbling system, we appeared lost down the funding rabbit hole once again. It was all about the money, just as it always has been.

But if Canada’s beleaguered health care system could be fixed solely with money, we wouldn’t be where we are today. After Prime Minister Justin Trudeau sat down with the premiers this week, there were signs that we could finally move beyond the dollar demands and start thinking about transformation — after the premiers first groused that it wasn’t enough, of course.

This is not to suggest money isn’t essential and the premiers weren’t right. The Liberal offer – and it really wasn’t an offer, it was a directive – was underwhelming. It was billions short of the aspirational fantasy of an immediate annual infusion of $28 billion in health transfers the provinces had been peddling. Instead, there is $46.2 billion in new money from Ottawa over 10 years and almost $200 billion over the decade in total health spending.

The premiers’ disappointment was real, but no one is going to walk away from an increase in health funding without risking the righteous anger of voters at the ballot box. They may have had their fiscal dreams, but they are grounded in political reality. Ontario Premier Doug Ford is leading here, indicating clearly he will take what he can get.

There would never be enough money for the premiers. There never has been. No premier has ever accepted a health transfer from Ottawa and said, “that’s enough, thanks, that will do just fine.”

But we point to Newfoundland and Labrador Premier Andrew Furey, himself a doctor: “It shouldn’t just be about money. It needs to be about modernization of a health-care system that is really stuck in the 1960s.” Furey believed some of the conversations this week would help start that modernization.

While underwhelming, there was still money on the table that pointed to reasons to believe that some improvement may be at hand, albeit short-lived.

There is an immediate, unconditional $2-billion available to deal with the crisis at our emergency rooms and pediatric hospitals. There is $1.7 billion for pay increases for personal support workers.

And there is $25 billion over 10 years for bilateral deals on “shared priorities” with the provinces, to improve patient access to primary health care, hire more doctors and nurses, enhance mental health services and build modern data systems to measure progress and results. This funding holds the promise at bringing some improvements to systemic problems such as staffing shortages. The conditions for specific data collection in areas such as surgery backlogs and access to a family doctor would bring additional transparency on how well provinces are performing in providing care.

But the deal amounts to a cheque — albeit one with big numbers — rather than true road map for the change health care professionals and even federal Health Minister Jean-Yves Duclos suggest is necessary.

After a meeting with his provincial counterparts in Vancouver last month, Duclos bemoaned the focus on money. “If there was anyone still doubting it, the current crisis is the undeniable proof that the old way doesn’t work. We need to do things differently.”

Certainly, the current pressures on the system are proof of that. More than six million Canadians have no access to a primary health provider. Their first point of health system contact then becomes the emergency room and they shouldn’t be there. That puts untenable pressures on ERs, delaying timely care for those who should be there, sometimes with tragic consequences.

There need to be new strategies for recruiting doctors, reducing their paperwork so they can see more patients, allow expedited credentialing across the country and for new arrivals from abroad and have more of the hands-on care done by nurse practitioners or in health care teams, including nurses and pharmacists (Ontario is moving in the latter direction).

There is a shortage of nurses across the country. Again their credentialing across the country and for new arrivals should be expedited but provincial poaching will not be a solution. A starting point would be raising their wages.

There is also a fiscal reality that the provinces don’t mention while they have their hands extended to Ottawa. A majority of them are in surplus, or can see a surplus just over the horizon, but the provincial share of health funding has barely kept up with pandemic-era inflation.

If Ford is still concerned about funding, he need only look under the cushions at Queen’s Park. According to the independent Financial Accountability Office, his Progressive Conservative government will have $12.5 billion in “excess funds” available over the next three years and is shortchanging health care by $5 billion. Additional provincial dollars are there for the medical needs of Ontario residents. They just haven’t been spent. Stashed in a contingency fund, that money is doing nothing to help remedy the crisis.

We may not yet be on the threshold of transformational change, but we need to turn the page on the never-ending funding battles. Some vision is now needed. Over to you, premiers.

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