The federal government’s offer of $46.2-billion in new funding over the next decade is a “ray of hope” for the country’s pandemic-battered health care system, but not enough to buy the fundamental change that many health leaders were seeking.
That was the initial reaction of some physicians, nurses and hospital executives who are now turning their attention to the nitty-gritty of the bilateral health funding deals that Prime Minister Justin Trudeau’s government has promised to negotiate with provinces and territories.
“This is definitely a bit of hope – a ray of hope – when it comes to seeing that things can change, but we actually have to see the follow through,” said Alika Lafontaine, president of the Canadian Medical Association and an anesthetist in Alberta. “We need the commitment.”
Mr. Trudeau’s plan, unveiled Tuesday at a meeting with premiers in Ottawa, amounted to $46.2-billion in new funding over 10 years, made up mostly of a modest increase to the Canada Health Transfer and $25-billion for bespoke agreements with provinces and territories.
While each jurisdiction will be able to tailor the bilateral deals to their needs, Ottawa set four broad priorities for the overall package. They include: access to high-quality family health services, including in rural and remote areas; a “resilient and supported” health work force; access to care for mental health and addictions; and providing patients access to their own electronic health information.
The plan also features $2-billion in immediate funding to stabilize pediatric hospitals and emergency rooms, $1.7-billion to raise the wages of personal support workers, and a repackaging of past Liberal election promises on mental health and long-term care.
The federal government said it would be providing nearly $200-billion to provinces for health care over the next decade, but three-quarters of that is regular Canada Health Transfer funding that premiers were banking on before Tuesday’s meeting, leaving some disappointed that Ottawa didn’t put more money on the table.
“If we look at the demands – the number of new Canadians we’re expecting a year and the aging of the population – it’ll come close to addressing inflation,” Kevin Smith, the president of Toronto’s University Health Network, said of the federal money. “It won’t come close to addressing massive transformation.”
Still, Dr. Smith said he was buoyed to see primary care and support for health workers get top billing in the announcement. When patients can’t find a family doctor or see the doctor they have, they often wind up in the emergency department of one of the hospitals he runs.
“It’s about access, quality and cost. That’s kind of the Holy Trinity of health care,” he said. “If we’re going to increase the spend in primary care, or hospital-based care, we want to know, ‘What are patients getting for that? Are they getting more rapid access? Are they getting higher quality of care?’”
Ottawa is trying to attach strings to the proposed funding to answer those questions. It is asking the premiers to support a national data-sharing system, and to draw up “action plans” for the future bilateral deals that include commitments to public reporting on whether the plans meet their goals.
For Danielle Martin, chair of the Department of Family and Community Medicine at the University of Toronto, successful reform of the primary-care system would mean every Canadian having access to a local health team, much like every child has a guaranteed spot in his or her local public school.
“I cannot think of a single good reason why we wouldn’t aim to have 100 per cent of Canadians who want it attached to a family doctor or nurse practitioner,” Dr. Martin said, adding that primary-care attachment is exactly the kind of data the system should be tracking.
The most recent Statistics Canada survey found that about 15 per cent of Canadians say they don’t have regular access to a health care provider.
Canada’s single-payer public-health system was already struggling to keep pace with the needs of a growing and aging population when COVID-19 struck. The punishing working conditions of the pandemic led many front-line health staff to retire early, drop down to part-time or quit their profession entirely.
Tuesday’s federal offer contained, “a lot of nice words” about recruiting more health workers, including from overseas, said Linda Silas, president of the Canadian Federation of Nurses Unions. But she hoped the Trudeau government would have more to say on improving the working conditions, pay and work-life balance for nurses.
“I’m very worried that nurses are not going to see themselves in anything that’s being proposed, and are going to be more discouraged,” Ms. Silas said.
Anthony Dale, the president of the Ontario Hospital Association, said that any day the federal government comes to the table with more money and a desire to improve the health system counts as a good day.
Still, he emphasized that unless Ottawa expands the Canada Health Act to cover more than medically necessary care in hospitals and physicians’ offices – which is all that is covered by the act today – hospitals will continue to be overwhelmed by patients whose needs aren’t being met in the community.
“We should be focusing, positively and constructively, on expanding our health care system beyond hospitals, beyond traditional physician services,” he said. “Making powerful revolutionary investments in home care, in particular, is where I think the greatest amount of focus needs to be.”
Ottawa has offered provinces and territories $46.2-billion in new health care funding, for a total of more than $191-billion over the next 10 years. Here are some key outcomes from Tuesday’s meeting in Ottawa to strike a deal.
The Globe and Mail